Balcı Mustafa Koray, Ciğer Ejder, Arslanoğlu Seçil, İşlek Akif
Department of Otorhinolaryngology, İzmir Katip Celebi University Atatürk Training and Research Hospital, Basın Sitesi Mh., Karabaglar, 35170, İzmir, Turkey.
Eur Arch Otorhinolaryngol. 2018 Oct;275(10):2555-2562. doi: 10.1007/s00405-018-5096-z. Epub 2018 Aug 17.
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.
Case series in a tertiary referral center.
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.
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.
介绍我们的头颈部坏死性筋膜炎（HNNF）病例系列的治疗结果，其中大多数病例在治疗中采用了负压封闭引流（VAC）。
在一家三级转诊中心进行病例系列研究。
2008年1月至2017年1月期间，11例患者接受了HNNF治疗。患者中2例为女性，9例为男性，平均年龄为57.1岁。口腔及气管切开/气管造口部位是感染的主要病因部位。3例患者接受了积极清创和传统敷料治疗，而8例患者接受了切开探查，随后进行了有限的皮肤切除和VAC敷料治疗。手术清创的平均次数为2.3次。平均住院时间为41.8天。除1例患者外，所有患者均观察到并发症。我们系列中HNNF的死亡率为18%。死亡原因1例为严重脓毒症和多器官功能衰竭，另1例为纵隔炎继发呼吸窘迫综合征。
HNNF仍然是一种致命疾病，手术清创至关重要。本研究是文献中唯一一组连续病例采用VAC治疗HNNF的病例系列。VAC治疗在HNNF患者的术后护理中可发挥重要作用。它减少了清创时切除的皮肤量，并促进伤口愈合。VAC治疗可与手术清创和药物治疗一起纳入HNNF的治疗方案。
