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  • Title: Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis.
    Author: Karkas A, Chahine K, Schmerber S, Brichon PY, Righini CA.
    Journal: Br J Surg; 2010 Apr; 97(4):609-15. PubMed ID: 20169565.
    Abstract:
    BACKGROUND: Cervical necrotizing fasciitis (CNF) associated with descending necrotizing mediastinitis (DNM) is a rapidly evolving and life-threatening condition. The aim of this retrospective study was to describe a treatment strategy for CNF with DNM and present a management algorithm for mediastinal extensions of CNF. METHODS: Patients diagnosed and treated for CNF with DNM over 14 years in a tertiary referral centre were included. RESULTS: Seventeen adult patients were included. The origin of infection was mainly oropharyngeal. The diagnosis of CNF/DNM was based on clinical and computed tomography findings. All patients underwent cervicotomy for CNF. In ten patients, DNM was located above the carina and could be accessed by a cervical approach. In seven patients, DNM was below the carina, and necessitated sternotomy for anteroinferior mediastinal involvement and posterolateral thoracotomy for posteroinferior mediastinal involvement. All patients received broad-spectrum antibiotics. One patient died 3 days after surgery. The median hospital stay was 30 days. There was no recurrence during long-term follow-up. CONCLUSION: Prompt diagnosis and early surgical treatment are essential for reducing mortality in CNF/DNM. All patients should undergo extensive cervicotomy. The surgical approach to the mediastinum depends on the supracarinal or infracarinal location of the disease.
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