Background Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. Methods A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." Results There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. Conclusion Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature.

Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients. A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors). During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population. The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

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Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital

https://doi.org/10.1016/j.ijscr.2022.107713

Pseudomonas aeruginosa as a culprit of cervical necrotizing fasciitis: A case report

Necrotizing Fasciitis called as flash eating disease is still prevalent in developing coun-tries. Surgical debridement under antibiotic cover is the mainstay of treatment and has usually good prognosis.

Necrotizing Fasciitis: Case series of four cases

Introduction Cervical necrotizing fasciitis is an acute, progressive, and rapidly spreading soft tissue infection affecting the fascial planes of the head and neck region. It has high morbidity and mortality rate. In this study, we have reviewed cervical necrotizing fasciitis cases treated in our department and analyzed the various risk factors, laboratory indices, and treatment modalities that affect the prognosis of this deadly disease. Design and method This is a retrospective review. We have reviewed the medical records and charts of seven patients hospitalized in our institute with the diagnosis of cervical necrotizing fasciitis between 2015 and 2019. Results Of the seven patients, six were male and one was female. The mean age was 49.8 years (range: 38-70 years). Etiology was found to be odontogenic infection in five (71%) cases. The presenting feature in all cases was tender cervical swelling. Intraoperatively, the submandibular triangle was found to be involved in all cases (100%) followed by the carotid triangle in five (71%) cases and the submental triangle in three (42%) cases. The most common comorbidities associated with cervical necrotizing fasciitis were found to be uncontrolled diabetes mellitus and anemia. All patients underwent emergency aggressive surgical debridement and culture-directed broad-spectrum antibiotics (100%). Additional procedures in the form of tracheostomy were required in two (28%) cases and skin grafting in two (28%) cases. One patient in our series developed sepsis with descending mediastinitis. The average hospital stay was 27 days. All the patients survived with no mortality. Conclusion Cervical necrotizing fasciitis should be diagnosed early. Early initiation of broad-spectrum antibiotics and aggressive surgical debridement are the two key management strategies that can improve survival. Strict glycemic control and correction of anemia result in a favorable outcome.

/pdf/cervical-necrotizing-fasciitis-an-institutional-experience-315bj7mj.pdf

Cervical Necrotizing Fasciitis: An Institutional Experience

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.

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Mohd Razif My

Papers

Necrotizing fasciitis of the head and neck: surgical outcomes in three cases.