Necrotizing fasciitis of the head and neck.

Background: Necrotizing fasciitis of the head and neck is a rapidly progressing and life-threatening condition. The purpose of this study was to describe the patients with a focus on clinical presentation, microbiology, treatment, and prognosis.

Patients and results: Seventeen patients (10 men; median age, 54 years) were included. Nine patients underwent minor head and neck surgery immediately prior to necrotizing fasciitis. The typical course was a quickly spreading erythema, pronounced tenderness, and severe pain. Imaging demonstrated diffuse swelling of the soft tissue, poorly differentiated dilated fat layers, and subcutaneous gas. All patients underwent surgical debridement within 2 days, and received broad-spectrum antibiotics and hemodynamic support, hyperbaric oxygen, and immunoglobulin. All patients survived, although 12 of 17 suffered sequelae.

Conclusions: Early diagnosis is of utmost importance. Quickly spreading erythema and extreme pain in the affected area serve as red flags. With the current intensive multimodality regimen, the mortality was zero, although 70% suffered sequelae.