Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
Head Neck. 2010 Dec;32(12):1592-6. doi: 10.1002/hed.21367.
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.
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.
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.
头颈部坏死性筋膜炎是一种迅速进展且危及生命的疾病。本研究旨在描述患者的临床表现、微生物学、治疗和预后。
共纳入 17 例患者（10 例男性；中位年龄 54 岁）。9 例患者在坏死性筋膜炎发生前接受了小型头颈部手术。典型的病程是迅速扩散的红斑、明显的压痛和剧烈疼痛。影像学显示软组织弥漫性肿胀，脂肪层扩张不明显，皮下积气。所有患者均在 2 天内接受了清创手术，并接受了广谱抗生素和血流动力学支持、高压氧和免疫球蛋白治疗。所有患者均存活，但 17 例中有 12 例出现后遗症。
早期诊断至关重要。受影响区域迅速扩散的红斑和极度疼痛是危险信号。采用当前强化的多模式治疗方案，死亡率为零，尽管 70%的患者出现后遗症。
