Vacuum-assisted closure for managing neck abscesses involving the mediastinum

Authors

  • Oreste Gallo MD,

    Corresponding author
    1. Academic Clinic of Otolaryngology and Head-Neck Surgery, Department of Surgical Sciences, University of Florence, Florence, Italy
    • Director of Academic Clinic of Otolaryngology and Head-Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
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  • Alberto Deganello MD, PhD,

    1. Academic Clinic of Otolaryngology and Head-Neck Surgery, Department of Surgical Sciences, University of Florence, Florence, Italy
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  • Giuseppe Meccariello MD,

    1. Academic Clinic of Otolaryngology and Head-Neck Surgery, Department of Surgical Sciences, University of Florence, Florence, Italy
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  • Rosario Spina MD,

    1. Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy
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  • Adriano Peris MD

    1. Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

A 57-year-old immunocompetent male patient with a deep neck abscess involving the mediastinum was referred to us following unsuccessful treatment at his local hospital with medical therapy and ultrasound-guided aspiration. After initial evaluation and resuscitation, a contrast-enhanced computed tomography (CT) scan was performed, and the patient was transferred for surgical drainage. A vacuum-assisted closure (VAC) device was used as a surgical drain to help prevent reaccumulation of the purulent collections. A repeat CT scan on day 3 confirmed the absence of residual pus in the mediastinum and in the neck spaces, and the VAC device was removed. Perfect healing of the deep tissues with successful mediastinal toilette was observed. The patient resumed oral meals on postoperative day 10, and 2 days later he was discharged. A 1-month follow-up CT again demonstrated the complete healing and absence of the neck abscess. This case illustrates the possibility of avoiding more extensive and life-threatening procedures, such as open thoracotomy, in the treatment of neck abscesses extending into the mediastinum, and highlights the utility of VAC in the management of deep neck abscesses. Laryngoscope, 2012

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