Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy

• Published in: European archives of oto-rhino-laryngology Vol. 275; no. 10; pp. 2555 - 2562
• Main Authors: Balcı, Mustafa Koray, Ciğer, Ejder, Arslanoğlu, Seçil, İşlek, Akif
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2018
• Subjects: Head & Neck; Head and Neck Surgery; Medicine; Medicine & Public Health; Neurosurgery; Otorhinolaryngology; Vacuum-assisted closure; Head and neck necrotising fasciitis; Necrotising fasciitis
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-018-5096-z

Objectives
To present the outcomes of our case series of head and neck necrotizing fasciitis (HNNF) in which vacuum-assisted closure (VAC) is used in most of the cases in the treatment.
Methods
Case series in a tertiary referral center.
Results
Eleven patients were treated for HNNF between January 2008 and January 2017. Patients were two females and nine males, the mean age was 57.1. Oral cavity and tracheotomy/tracheostomy sites were the main aetiological foci of the infection. Three patients were treated with aggressive debridements and conventional dressing, whereas eight patients were treated with incision and exploration followed by limited skin excisions and VAC dressing. The mean number of surgical debridements was 2.3. The mean length of hospital stay was 41.8 days. Complications were observed in all patients except one. The mortality rate of HNNF in our series was 18%. The cause of death was severe sepsis and multi-organ failure in one case and mediastinitis followed by respiratory distress syndrome in the other case.
Conclusion
HNNF is still a mortal disease and surgical debridements are crucial. The current study is the only case series in the literature in which VAC treatment was used in consecutive cases of HNNF. VAC treatment can play a major role in the post-operative care of HNNF patients. It reduces the amount of excised skin during debridements and stimulates wound healing. VAC treatment may be included in the treatment protocol of HNNF alongside surgical debridements and medical therapy.