Successfully treated descending necrotizing mediastinitis through thoracotomy using a pedicled muscular serratus anterior flap
| Autor: | G. Merlusca, Céline Haremza, Florence De Dominicis, Pascal Berna |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment Surgical Flaps Necrosis medicine Humans Pericardium Thoracotomy Radical surgery Muscle Skeletal Therapeutic Irrigation Abscess Aged business.industry Mediastinum Pedicled Flap medicine.disease Mediastinitis Anti-Bacterial Agents Surgery Treatment Outcome medicine.anatomical_structure Debridement Cellulitis Female Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. 13:456-458 |
| ISSN: | 1569-9285 1569-9293 |
| DOI: | 10.1510/icvts.2011.273813 |
| Popis: | Descending necrotizing mediastinitis (DNM) is rare and aggressive. A 68-year-old female with no medical history, was admitted to our institution for cervical cellulitis. After a conventional medical treatment, multiple abscesses of the upper mediastinum appeared on computed tomography (CT) findings. Although two cervicotomies were performed, a new necrotic abscess appeared in the anterior upper and middle mediastinum. An extensive debridement of cellulitis and abscess extended to the pericardium was made by thoracotomy. Middle mediastinum and pericardium were covered and reconstructed by a right pedicled serratus anterior flap. After radical surgery, follow-up was uneventful. Early extensive and complete debridement of cervical and mediastinal collections and irrigation with broad-spectrum intravenous antibiotics is essential. Combined surgery is the best approach in DNM. The use of a pedicled muscular flap helps control the sepsis. In such cases, serratus anterior flap is a flap of choice because it is reliable and always available even in a skinny patient, contrary to omentum. In this lifethreatening disease, an early aggressive combined surgery with debridement of all necrotic tissues extended to the pericardium if necessary associated with a pedicled flap is mandatory. 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|