Drainage of Severe Descending Mediastinitis: 5-Year Experience in a Single Tertiary Institution

Objective: Descending necrotizing mediastinitis is caused by the spread of the infection to the mediastinum from the deep and superficial cervical fascial planes. Surgical drainage of severe descending necrotizing mediastinitis was done through an invasive transthoracic and transcervical approach. In this study, we described a series of severe descending necrotizing mediastinitis treated with the only transcervical approach with or without vacuum-assisted dressing. Methods: A retrospective, single-institution study was performed to evaluate the outcome of patients with descending necrotizing mediastinitis managed from June 2015 until March 2020. Results: A total of 5 patients were identified. All subjects underwent transcervical drainage of descending necrotizing mediastinitis. Vacuumassisted dressing was applied to 3 patients. One subject belonged to type I, and there were 2 each for type Ila and I lb according to Endo et al's3 computed tomography classification. All patients survived with only transcervical drainage, without the invasive transthoracic approach. The mean duration from the time of admission to surgical drainage was 10.3 hours. The mean length of the vacuum-assisted dressing application was 11 days. All patients were discharged from the hospital, with complete resolution of disease. Conclusion: Less invasive transcervical drainage may be adequate in treating severe descending necrotizing mediastinitis, as long as early treatment is recognized and initiated. Incorporating vacuum-assisted dressing in the treatment course may open the door for a new algorithm.