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NECROTIZING FASCIITIS OF THE NECK

MARIJAN KOVAČIĆ ; ENT Department, Zadar General Hospital, Zadar, Croatia
IVAN KOVAČIĆ ; Department of Surgery, Zadar General Hospital, Zadar, Croatia
BORIS ĐELALIJA ; Department of Infectology, Zadar General Hospital, Zadar, Croatia

Abstract

Necrotizing fasciitis is a rare and rapidly progressive infection characterized by necrosis of the superficial fascia and spread on the surrounding skin or muscles, which can be fatal. It usually occurs in the limbs, abdominal wall and perineum. In this retrospective review, the authors present 15 patients with cervical necrotizing fasciitis. The patient mean age was 54.7 years and they had one or more comorbid health problems. Five of them had descending necrotizing mediastinitis and three had progressive sepsis with toxic shock syndrome. Broad-spectrum intravenous antibiotic therapy was administered to all patients immediately, and in three of them we used five-day intravenous immunoglobulin therapy for the signs of toxic shock syndrome. After positive computed tomography imaging for necrotizing fasciitis, we used surgical exploration and debridement of necrotic tissue. In five patients, the initial surgery also included mediastinal transcervical drainage. Preoperative tracheotomy was performed in six patients and delayed tracheotomy in one patient. Histopathologically, all cases showed extensive necrosis of debrided fascia and vascular thrombosis of the neck soft tissue. The mortality rate was 6.7% (1/15). The authors point to the importance of early diagnosis and timely surgical management, broad-spectrum antibiotics and intravenous immunoglobulin therapy when patients are too unstable to undergo surgery.

Keywords

neck; necrotizing fasciitis; tracheotomy; descending mediastinitis; immunoglobulin G

Hrčak ID:

111247

URI

https://hrcak.srce.hr/111247

Publication date:

28.11.2013.

Article data in other languages: croatian

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