• Journal of Chest Surgery
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• v.24 no.12
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• pp.1228-1231
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• 1991

One of the most lethal forms of mediastinitis is descending necrotizing mediastinitis, in which infection arising from the oropharynx spreads to the mediastinum. Despite the development of computed tomographic scanning to aid in the early diagnosis of mediastinitis, the past 30 years, in large part because of continued dependence on transcervical mediastinal drainage, Although transcervical drainage is usually effective in the treatment of acute mediastinitis due to a cervical esophageal perforation, these approach in the patient with descending necrotizing mediastinitis fails to provide adequate drainage and pre-disposes to sepsis and a poor outcome. In addition to cervical drainage, aggressive, early mediastinal exploration - debridement and drainage through a subxiphoid incision or thoracotomy - is advocated to salvage the patient with descending necrotizing mediastinitis.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.36-41
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• 2012

Background : Poststernotomy mediastinitis is a rare, but life-threatening complication, thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated. Methods : Between September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps, advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control, postoperative morbidity, and mortality. Results : All patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery. Conclusions : Immediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis, and is associated with minimal morbidity and mortality.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.378-379
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• 2015

Mediastinitis is a life-threatening disease, and effective drainage is needed to treat mediastinitis with abscess formation. We recommend an alternative drainage method using chest tube binding with a Silastic Penrose drainage tube. The use of a Silastic Penrose drainage tube may help to manage mediastinitis with abscess formation. This method facilitates effective draining and prevents tissue adhesion.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.296-301
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• 1995

Acute mediastinitis is almost always secondary to some other condition, and most cases are due to esophageal perforation. Although acute mediastinitis from odontogenic infection is extremely rare in the era of antibiotic drugs, some more fulminant odontogenic infections can produce complications including airway obstruction, necrotizing fascitis and extension of the infection to thorax. Irrespective of the changing incidence of etiologic factors, unless the pathophysiology of acute mediastinitis and its causes are understood and the conditions promptly recognized and properly treated, the result may be prolonged illness and even death. We experienced a case of odontogenic infection followed by acute mediastinitis and present review of literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.6
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• pp.538-542
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• 2010

Acute mediastinitis is a fatal infection which occurs related to connective tissue of mediastium, in the thoratic organs. Occurrence of mediastinitis due to craniocervical infection is very rare, and is defined as descending necrotizing mediastinitis. November 8th, 2008, man in his early fifties visited ER due to severe swelling on left neck area and dyspnea. Antibiotic were administered immediately, and vast amount of abscess formation on pneumomediastinum and adjacent tissues were observed via chest computed tomography. With cooperation of thoracic and cardiovascular surgery department, emergency incision and drainage with drain insertion was done to remove abscess, and control the infection. After surgery, everyday saline irrigation through drain was done during hospitalization, with continues antibiotic therapy. Descending necrotising mediastinitis is a most rare and dangerous infection which occurs on oropharyngeal area. In case of descending necrotising mediastinitis, accurate diagnosis, airway maintenance, remove of abscess by incision and drainage, aggressive antibiotic therapy and continuous saline irrigation is necessary to increase patient survivability. Also, computed tomography with contrast media is essential to figure out the size and location of the infection and abscess formation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.577-581
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• 2010

Descending necrotizing mediastinitis (DNM) is a complication of odontogenic or oropharyngeal infections that can spread to the mediastinum. Such infections is serious, leading to sepsis and frequently to death. Even in this era of antibiotics, the mortality rate associated with DNM is approximately 40%. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. Delayed diagnosis is the principal reason for the high mortality in DNM. Therefore, descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. We experienced a case of odontogenic infection followed by acute mediastinitis, so present now with the review of literatures.

• Journal of Chest Surgery
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• v.39 no.9 s.266
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• pp.699-701
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• 2006

Mediastinitis and sternal wound infection frequently occurred after corrective surgery for complex heart anomalies. Most of the patients are neonate or infant and they have showed low oxygen tension. For that poor condition, application of invasive treatment of mediastinitis is not appropriate and recovery takes a long time. We successfully treated a mediastinitis after Norwood operation using vacuum assisted closure. So we introduce the technique and the modification of neonatal vacuum assisted closure.

• Korean Journal of Bronchoesophagology
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• v.2 no.2
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• pp.253-257
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• 1996

Deep neck infections were flirty common and a source of considerable morbidity and mortality. Although the advent of antibiotics has reduced the overall number of deep neck infections, they still occur in the general population. There are several new groups of patients at risk for deep neck infections, such as immunocompromised individuals, those with underlying diseases. Prevention of the severe sequale that may be associated with deep neck infections- mediastinitis, airway obstruction, carotid artery hemorrhage, aspiration pneumonia, septicemia - requires a knowledge of various portals of entry for infection, the presenting sign and symptoms, the possible microbiologic features, appropriate laboratory and radiologic workups, therapeutic techniques, and the ongoing medical management. A prompt diagnosis and institution of therapy will shorten the course of required treatment and reduce morbility and mortility. The authors have experienced one case of acute mediastinitis in deep neck infection patient with diabetes mellitus.

• Korean Journal of Bronchoesophagology
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• v.12 no.2
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• pp.42-46
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• 2006

Descending necrotizing mediastinitis (DNM) is defined as mediastinal infection that begins at the cervical region and spread through deep fascial planes into the mediastinum. This is a rare and life-threatening complication of deep neck space infection. As infection reaches the mediastinum, widespread cellulitis, necrosis, abscess formation and sepsis may occur. So, early diagnosis and immediate antibiotics and surgical treatment are required to improve the poor prognosis of DNM. We present four cases of deep neck infection causing a virulent mediastinitis with a literature review.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.722-724
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• 1998

Acute mediastinitis and subsequent graft infection following aorta surgery poses a difficult problem, as infected synthetic material must be completely removed for resolution of infection. Here we report a case of successful management of acute mediastinitis following hemiarch replacement for acute aortic dissection with omental flap transfer leaving infected graft in situ.