HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael Lanuti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lanuti, M. Search for Related Content PubMed PubMed Citation Articles by Lanuti, M. Related Collections Mediastinum Related Article

Ann Thorac Surg 2007;83:396
© 2007 The Society of Thoracic Surgeons

---

Original Articles: General Thoracic

Invited commentary

55 Fruit St, Blake 1570, Boston, MA 02114

(Email: mlanuti{at}partners.org).

The current study by Gorlitzer and colleagues [1] describes an alternative approach to the treatment of descending necrotizing mediastinitis in 5 patients at a single institution. Although a variety of surgical approaches (ie, transcervical, subxiphoid, transthoracic, and transternal) have been adopted and published, no single approach has been widely accepted as the optimal form of mediastinal drainage. The authors prefer median sternotomy as the primary mode of debridement followed by vacuum-assisted drainage and delayed sternal closure. The use of a vacuum-assisted wound closure device for the treatment of descending necrotizing mediastinitis is relatively novel. Despite a favorable outcome in 80% of the patients, one of the major criticisms of this approach includes the potential transmission of infectious complications to the sternum. Moreover, the risk of sternal osteomyelitis is compounded by the need for tracheostomy in many of these patients.

We all agree that early surgical intervention is paramount in patients who present with descending necrotizing mediastinitis. High resolution chest imaging with computed tomography provides the best road map for developing a surgical strategy for optimal debridement and drainage. Treatment should be individualized to each patient since the disease process is not uniform. Each surgical approach offers potential advantages and disadvantages. Descending infections in the posterior mediastinum are probably best drained through a transthoracic approach while infections in the anterior or middle mediastinum (pretracheal or perivascular space) can be approached with combined techniques. Although median sternotomy has not been historically favored in the literature for the treatment of descending mediastinitis [2], Gorlitzer and colleagues [1] should be commended on their good outcomes and the absence of sternal osteomyelitis or sternal wound dehiscence in their patients.

	References

Top References

 

1. Gorlitzer M, Grabenwoeger M, Meinhart J, et al. Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy Ann Thorac Surg 2007;83:393-396.[Abstract/Free Full Text]
2. Papalia E, Rena O, Oliaro A, et al. Descending necrotizing mediastinitis: surgical management Eur J Cardiothorac Surg 2001;20:739-742.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael Lanuti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lanuti, M. Search for Related Content PubMed PubMed Citation Articles by Lanuti, M. Related Collections Mediastinum Related Article