Case report: Deep neck abscess and mediastinitis with exposed carotid sheath treated with vacuum assisted closure

Abstract

Background We present a deep neck infection associated with mediastinitis treated with VAC therapy. In this case we encountered exposure of the carotid sheath, and protected with GELFOAM® (Pfizer®) sponge and ACTICOAT FLEX 3® (Smith&Nephew®), as an alternative to petroleum gauze. Case summary A 29-year-old female with deep neck abscess and mediastinitis involving carotid sheath. Treated with VAC therapy, right thoracotomy and left thoracoscopy with decortication. During the VAC changes carotid sheath was covered by a layer of Gelfoam® and Acticoat flex3®. A total of 3 changes were performed with direct wound closure with no evidence of vascular direct injury. Conclusion The present case demonstrates that alternative dressing choices such as GELFOAM® and ACTICOAT FLEX3® can potentially be used instead of the classic petroleum gauze for Negative Pressure Therapy for wounds with exposed vessels. More prospective randomized trials should be performed to ensure this proposal safety. We believe that the microporous layer decreases the direct negative pressure in the vessels. We did not find complications related to this treatment, but we cannot assume they are nonexistent. Highlights

Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

“…Surgical debridement of this area and subsequent wound closure poses a significant challenge for the head and neck surgeon. One study in our review successfully utilized NPWT in the setting of an exposed carotid sheath . Although further studies are needed to determine the practicality and effectiveness of this application, it offers an alternative option for the management of deep neck wounds involving major vessels.…”

İdeal Yara Örtüsünün Özelli̇kleri̇

“…Biatain ® is another flexible dressing produced in suitable forms for different parts of the body [54]. Acticoat ® Flex 3 and 7 are made from a single braided polyester material that promises to minimize discomfort and local trauma for the patient [55,56].…”