title: Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder.
abstract: Descending necrotizing mediastinitis (DNM) is a rapidly progressive disease from the spread of cervical infection. Transcervical and transthoracic drainage was the recognized traditional surgical approach to achieve adequate clearance of infection. Non-invasive vacuum-assisted dressing is a new technique where applied negative pressure can help remove infective fluid and to promote wound healing. A 60-year-old man presented with odynophagia, fever and anterior neck swelling for 2 weeks. He was diagnosed to have anterior neck abscess and underwent surgical drainage. However, it did not respond well, but progressed to involve superior and inferior mediastinum. Vacuum-assisted dressing was applied for total of 2 weeks and the patient recovered without going through usual traditional transthoracic drainage. Vacuum drainage is a simple, safe and non-invasive method of managing DNM, in well selected group with small abscess cavity without airway obstruction and septicemia. This potential technique can lead to paradigm shift in treating life-threatening DNM.
authors.affiliation: Department of Otorhinolaryngology, University Malaya, Kuala Lumpur, Malaysia. lyewtoong@yahoo.com.
authors.forename: Y T
authors.initials: YT
authors.lastname: Liew
authors.affiliation: Department of Otorhinolaryngology, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Elizabeth Yenn Lynn
authors.initials: EY
authors.lastname: Lim
authors.affiliation: Department of Otorhinolaryngology, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: A B
authors.initials: AB
authors.lastname: Zulkiflee
authors.affiliation: Department of Otorhinolaryngology, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: N
authors.initials: N
authors.lastname: Prepageran
mesh_terms: D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D009336:Necrosis / Q000628:therapy; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Descending necrotizing mediastinitis; Transthoracic; Vacuum-assisted dressing