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 head and neck region the origin is odontogenic or pharyngolaryngeal; predominantingly identified bacteria are Streptococci and Staphylococci. Characteristic CT finding is gas demonstration, 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 hemorrhage. A fulminant CNF course requires timely implementation of appropriate treatment. Broad-spectrum antibiotic therapy and repeated surgical interventions with the removal of necrotic tissues is most common treatment. Open wound treatment increases the risk of additional coinfection and sepsis; modern approach is usage 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. Authors describe case of 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 healing of the graft.