Korean J Thorac Cardiovasc Surg 2015;48:378-379 ISSN: 2233-601X (Print)
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http://dx.doi.org/10.5090/kjtcs.2015.48.5.378
ISSN: 2093-6516 (Online)
A Novel Mediastinal Drainage Tube for Mediastinitis Jun Ho Yhang, M.D.1,2, In-Seok Jang, M.D.1,2, Sung Hwan Kim, M.D.1,2, Hyun Ho Park, M.D.1,2, Dong Hoon Kang, M.D.1,2, Jun Young Choi, M.D.1,2
Mediastinitis is a life-threatening disease, and effective drainage is needed to treat mediastinitis with abscess formation. We recommend an alternative drainage method using chest tube binding with a Silastic Penrose drainage tube. The use of a Silastic Penrose drainage tube may help to manage mediastinitis with abscess formation. This method facilitates effective draining and prevents tissue adhesion. Key words: 1. Mediastinitis 2. Mediastinal abscess
Mediastinitis is a highly lethal disease. Prompt diagnosis is
We have employed another method for pleural space drain-
paramount, and aggressive surgical mediastinal drainage is the
age, in which a Silastic Penrose drainage tube is linked with
treatment of choice [1]. Most acute mediastinal infections re-
the distal part of the usual chest tube by suturing. The
sult from either esophageal perforation or descending necrot-
Silastic Penrose drainage tube gives us the ability to place
izing mediastinitis from odontogenic deep neck infection [2].
the tube at the loculating space and creates a patent space for
Long-term effective drainage is needed until the esophageal
drainage while preventing tissue adhesion. The longitudinal
perforation site heals or the infection leading to acute media-
Silastic Penrose drainage groove keeps the space patent in or-
stinitis is controlled.
der to prevent adhesion processes.
Wide-spectrum antibiotics and total parenteral nutrition are
The connection is made with large-bored non-absorbable
also helpful in the management of acute mediastinitis [3].
sutures between the chest tube and the Silastic Penrose drain-
However, effective surgical drainage is considered to be the
age tube (Fig. 1). We customized the Silastic Penrose drain-
primary principle of mediastinitis management. Mediastinal
age tube portion with multiple oblique half-cuts for more ef-
abscesses usually form with multiple pus loculations.
fective drainage (Fig. 2).
In thoracic surgery, surgeons have frequently used chest
We recommend the use of three fixations between the
tube drainage for the evacuation of air, blood, and purulent
chest tube and the Silastic Penrose drainage tube. Large-bore
pleural effusions. A chest tube has several holes for effective
sutures are preferred to fix the tube. We have used this chest
drainage at its distal part. However, chest tubes are made
tube in the management of acute mediastinitis for the last 10
with hard silicone material. A more flexible drainage tube
years. Over 20 patients have been treated with this drainage
may help ensure effective drainage.
tube (Fig. 3). This type of chest tube may be another method
1
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of 2 Medicine, Institite of Health Sciences, Gyeongsang National University Received: December 3, 2014, Revised: March 4, 2015, Accepted: March 4, 2015, Published online: October 5, 2015 Corresponding author: In-Seok Jang, Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Korea (Tel) 82-55-750-8121 (Fax) 82-55-753-8138 (E-mail) [email protected] C The Korean Society for Thoracic and Cardiovascular Surgery. 2015. All right reserved. CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Mediastinal Drainage Tube
Fig. 1. The drainage tube is made with a chest tube and a Silastic Penrose drainage tube. The suture is performed three times using large-bored, non-absorbable material.
Fig. tube cuts eter
2. Diagonal cuts are made on the Silastic Penrose drainage in an alternating fashion for effective drainage. The diagonal should not be larger than one half of the width of the diamof the Silastic Penrose tube.
Fig. 3. This computed tomography image shows (A) a mediastinal abscess and (B) mediastinal drainage using a chest tube with a Silastic Penrose drainage tube in the mediastinal space. for managing mediastinal abscesses.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
REFERENCES
infections and predisposing factorsformediastinalextension. Korean J Thorac Cardiovasc Surg 2012;45:171-6. 2. Yu J, Lim S, Lee S, et al. Clinial analysis of surgical management for descending necrotizing mediastinitis. Korean J Thorac Cardiovasc Surg 2008;41:463-8. 3. Singhal P, Kejriwal N, Lin Z, Tsutsui R, Ullal R. Optimal surgical management of descending necrotising mediastinitis: our experience and review of literature. Heart Lung Circ 2008;17:124-8.
1. Kang S, Lee S, Oh H, et al. Clinical features of deep neck
− 379 −
□ How to Do It □
http://dx.doi.org/10.5090/kjtcs.2015.48.5.378
ISSN: 2093-6516 (Online)
A Novel Mediastinal Drainage Tube for Mediastinitis Jun Ho Yhang, M.D.1,2, In-Seok Jang, M.D.1,2, Sung Hwan Kim, M.D.1,2, Hyun Ho Park, M.D.1,2, Dong Hoon Kang, M.D.1,2, Jun Young Choi, M.D.1,2
Mediastinitis is a life-threatening disease, and effective drainage is needed to treat mediastinitis with abscess formation. We recommend an alternative drainage method using chest tube binding with a Silastic Penrose drainage tube. The use of a Silastic Penrose drainage tube may help to manage mediastinitis with abscess formation. This method facilitates effective draining and prevents tissue adhesion. Key words: 1. Mediastinitis 2. Mediastinal abscess
Mediastinitis is a highly lethal disease. Prompt diagnosis is
We have employed another method for pleural space drain-
paramount, and aggressive surgical mediastinal drainage is the
age, in which a Silastic Penrose drainage tube is linked with
treatment of choice [1]. Most acute mediastinal infections re-
the distal part of the usual chest tube by suturing. The
sult from either esophageal perforation or descending necrot-
Silastic Penrose drainage tube gives us the ability to place
izing mediastinitis from odontogenic deep neck infection [2].
the tube at the loculating space and creates a patent space for
Long-term effective drainage is needed until the esophageal
drainage while preventing tissue adhesion. The longitudinal
perforation site heals or the infection leading to acute media-
Silastic Penrose drainage groove keeps the space patent in or-
stinitis is controlled.
der to prevent adhesion processes.
Wide-spectrum antibiotics and total parenteral nutrition are
The connection is made with large-bored non-absorbable
also helpful in the management of acute mediastinitis [3].
sutures between the chest tube and the Silastic Penrose drain-
However, effective surgical drainage is considered to be the
age tube (Fig. 1). We customized the Silastic Penrose drain-
primary principle of mediastinitis management. Mediastinal
age tube portion with multiple oblique half-cuts for more ef-
abscesses usually form with multiple pus loculations.
fective drainage (Fig. 2).
In thoracic surgery, surgeons have frequently used chest
We recommend the use of three fixations between the
tube drainage for the evacuation of air, blood, and purulent
chest tube and the Silastic Penrose drainage tube. Large-bore
pleural effusions. A chest tube has several holes for effective
sutures are preferred to fix the tube. We have used this chest
drainage at its distal part. However, chest tubes are made
tube in the management of acute mediastinitis for the last 10
with hard silicone material. A more flexible drainage tube
years. Over 20 patients have been treated with this drainage
may help ensure effective drainage.
tube (Fig. 3). This type of chest tube may be another method
1
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of 2 Medicine, Institite of Health Sciences, Gyeongsang National University Received: December 3, 2014, Revised: March 4, 2015, Accepted: March 4, 2015, Published online: October 5, 2015 Corresponding author: In-Seok Jang, Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Korea (Tel) 82-55-750-8121 (Fax) 82-55-753-8138 (E-mail) [email protected] C The Korean Society for Thoracic and Cardiovascular Surgery. 2015. All right reserved. CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
− 378 −
Mediastinal Drainage Tube
Fig. 1. The drainage tube is made with a chest tube and a Silastic Penrose drainage tube. The suture is performed three times using large-bored, non-absorbable material.
Fig. tube cuts eter
2. Diagonal cuts are made on the Silastic Penrose drainage in an alternating fashion for effective drainage. The diagonal should not be larger than one half of the width of the diamof the Silastic Penrose tube.
Fig. 3. This computed tomography image shows (A) a mediastinal abscess and (B) mediastinal drainage using a chest tube with a Silastic Penrose drainage tube in the mediastinal space. for managing mediastinal abscesses.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
REFERENCES
infections and predisposing factorsformediastinalextension. Korean J Thorac Cardiovasc Surg 2012;45:171-6. 2. Yu J, Lim S, Lee S, et al. Clinial analysis of surgical management for descending necrotizing mediastinitis. Korean J Thorac Cardiovasc Surg 2008;41:463-8. 3. Singhal P, Kejriwal N, Lin Z, Tsutsui R, Ullal R. Optimal surgical management of descending necrotising mediastinitis: our experience and review of literature. Heart Lung Circ 2008;17:124-8.
1. Kang S, Lee S, Oh H, et al. Clinical features of deep neck
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