Vacuum assisted closure for descending necrotizing mediastinitis. A case report

Mediastinitis is a severe infection of the mediastinal connective tissue, great vessels, heart and surrounding structures, Descending necrotizing mediastinitis is the fatal form of mediastinitis an usually develops as a complication of peritonsillar abscesses or dental-odontogenic infection. Delay in the treatment of a severe infection that starts in the pharynx leads to the spread of the suppurative infection through the deep and superficial cervical fascial spaces to the mediastinum. In most cases a mixed infection from aerobic and anaerobic species. The disease is classified into two types as focal and diffuse type.

Mediastinitis can be managed by antibiotic therapy, wound incision and drainage, debridement, rewiring, closed irrigation, delayed closure and omental or myocutaneous flap reconstruction. Of considerable importance is the use of negative pressure to enhance wound granulation and closure as initially described by Davydov in early 1990. The technique known as vacuum-assisted closure (VAC) was later successfully adapted for surgical wound management. VAC is an alternative wound healing strategy in mediastinitis, and recent studies have reported promising results although studies comparing VAC with open packing are scarce.