Skip to main content

Advertisement

SpringerLink
Log in

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

  • Head & Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wilson B (1952) Necrotizing fasciitis. Am Surg 18:416–431

    PubMed  CAS  Google Scholar 

  2. Fernando DM, Kaluarachchi CI, Ratnatunga CN (2013) Necrotizing fasciitis and death following an insect bite. Am J Forensic Med Pathol 34:234–236

    Article  PubMed  Google Scholar 

  3. Wilkerson R, Pauli W, Coville FV (1987) Necrotizing fasciitis: review of the literature and case report. Clin Orthop Relat Res 216:187–192

    Google Scholar 

  4. Fink A, DeLuca G (2002) Necrotizing fasciitis: pathophysiology and treatment. Dermatol Nurs 14:324–327

    PubMed  Google Scholar 

  5. Kessenich CR, Bahl A (2004) Necrotizing fasciitis: understanding the deadly results of the uncommon ‘flesh-eating bacteria’. Am J Nurs 104:51–55

    Article  PubMed  Google Scholar 

  6. Stone HH, Martin J Jr (1972) Synergistic necrotizing cellulitis. Ann Surg 175:702–711

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Lin C, Yeh FL, Lin JT, Ma H, Hwang CH, Shen BH, Fang RH (2001) Necrotizing fasciitis of the head and neck: an analysis of 47 cases. Plast Reconstr Surg 107:1684–1693

    Article  PubMed  CAS  Google Scholar 

  8. Jallali N, Whitney S, Butler PE (2005) Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg 189:462–466

    Article  PubMed  CAS  Google Scholar 

  9. Novelli G, Catanzaro S, Canzi G, Sozzi D, Bozzetti A (2014) Vacuum assisted closure therapy in the management of cervico-facial necrotizing fasciitis: a case report and review of the literature. Minerva Stomatol 63:135–144

    PubMed  CAS  Google Scholar 

  10. Wong CH, Khin LW, Heng KS, Tan KC, Low CO (2004) The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 32:1535–1541

    Article  PubMed  Google Scholar 

  11. Endo S, Murayama F, Hasegawa T, Yamamoto S, Yamaguchi T, Sohara Y, Fuse K, Miyata M, Nishino H (1999) Guideline of surgical management based on diffusion of descending mediastinitis. Jpn J Thorac Cardiovasc Surg 47:14–19

    Article  PubMed  CAS  Google Scholar 

  12. Mao JC, Carron MA, Fountain KR, Stachler RJ, Yoo GH, Mathog RH, Coticchia JM (2009) Craniocervical necrotizing fasciitis with and without thoracic extension: management strategies and outcome. Am J Otolaryngol 30:17–23

    Article  PubMed  Google Scholar 

  13. Argenta L, Morykwas M (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plastic Surg 38:563–577

    Article  CAS  Google Scholar 

  14. Oczenski W, Waldenberger F, Nehrer G, Kneifel W, Swoboda H, Schwarz S, Fitzgerald RD (2004) Vacuum-assisted closure for the treatment of cervical and mediastinal necrotizing fasciitis. J Cardiothorac Vasc Anesth 18:336–338

    Article  PubMed  Google Scholar 

  15. Sumi Y, Ogura H, Nakamori Y, Ukai I, Tasaki O, Kuwagata Y, Shimazu T, Tanaka H, Sugimoto H (2008) Nonoperative catheter management for cervical necrotizing fasciitis with and without descending necrotizing mediastinitis. Arch Otolaryngol Head Neck Surg 134:750–756

    Article  PubMed  Google Scholar 

  16. Krenk L, Nielsen HU, Christensen ME (2007) Necrotizing fasciitis in the head and neck region: an analysis of standard treatment effectiveness. Eur Arch Otorhinolaryngol 264:917–922

    Article  PubMed  Google Scholar 

  17. Lanisnik B, Cizmarevic B (2010) Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience. Eur Arch Otorhinolaryngol 267:415–421

    Article  PubMed  Google Scholar 

  18. Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJE, Inaba K, Perry JJ (2018) Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000002774

    Article  PubMed  Google Scholar 

  19. Martinez M, Peponis T, Hage A et al (2018) The role of computed tomography in the diagnosis of necrotizing soft tissue infections. World J Surg 42:82–87

    Article  PubMed  Google Scholar 

  20. Kehrl T (2014) Point-of-care ultrasound diagnosis of necrotizing fasciitis missed by computed tomography and magnetic resonance imaging. J Emerg Med 47:172–175

    Article  PubMed  Google Scholar 

  21. Yen ZS, Wang HP, Ma HM, Chen SC, Chen WJ (2002) Ultrasonographic screening of clinically-suspected necrotizing fasciitis. Acad Emerg Med 9:1448–1451

    Article  PubMed  Google Scholar 

  22. Malghem J, Lecouvet FE, Omoumi P, Maldague BE, Vande Berg BC (2013) Necrotizing fasciitis: contribution and limitations of diagnostic imaging. Joint Bone Spine 80:146–154

    Article  PubMed  Google Scholar 

Download references

Funding

The research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, İzmir Katip Celebi University Atatürk Training and Research Hospital, Basın Sitesi Mh., Karabaglar, 35170, İzmir, Turkey

    Mustafa Koray Balcı, Ejder Ciğer, Seçil Arslanoğlu & Akif İşlek

Authors
  1. Mustafa Koray Balcı
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ejder Ciğer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seçil Arslanoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akif İşlek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mustafa Koray Balcı.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balcı, M.K., Ciğer, E., Arslanoğlu, S. et al. Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy. Eur Arch Otorhinolaryngol 275, 2555–2562 (2018). https://doi.org/10.1007/s00405-018-5096-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5096-z

Keywords

Search

Navigation