Cervical necrotizing fasciitis complicated by sepsis case report

Abstract

Cervical necrotizing fasciitis (CNF) is uncommon, difficult to diagnose, and rapidly progressive severe infection causing necrosis of subcutaneous tissue and fascial compartments, associated with high mortality; early recognition and surgical intervention are crucial. In most cases of nercrotizing fasciitis in the head and neck region the origin is odontogenic or pharyngolaryngeal; predominantly identified bacteria are Streptococci and Staphylococci. A characteristic CT finding is gas demonstration. The main complication is descending necrotizing mediastinitis (DNM), unfrequently vascular entities: internal jugular vein thrombosis, carotid sheath necrosis, carotid artery aneurysm and rupture, and other arterial hemorrhages. A fulminant CNF course requires timely implementation of appropriate treatment. Broad-spectrum antibiotic therapy and repeated surgical interventions with the removal of necrotic tissues constitute the most common treatment. Open wound treatment increases the risk of additional coinfection and sepsis; a modern approach is the use of negative pressure wound therapy or percutaneous catheter drainage. Tracheostomy may be helpful in need of further, repetitive debridement. Loss of soft tissues and skin of the neck may require reconstruction with full- or split-thickness free flap, local flap, or biodegradable dermal substitute. The authors describe the case of a patient with CNF complicated by sepsis. The necrosis resulted in a 10x20-cm defect in the front of the neck, which was covered with a split-thickness graft harvested from the anterolateral surface of the thigh. No complications occurred during the healing of the graft.