Sidam Shaila, Bhagat Abhinav, Chavan Aparna, Sahoo Anjan K
Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Cureus. 2023 Sep 4;15(9):e44678. doi: 10.7759/cureus.44678. eCollection 2023 Sep.
Cervical necrotizing fasciitis is an immensely progressive, difficult-to-diagnose soft tissue infection of the fascial planes, skin, and subcutaneous tissue. It has marked morbidity and mortality. In this case report, we analyzed the risk factors, laboratory indices, and treatment modalities that affect the outcome of this fatal disease. This is a retrospective case series of cases admitted within a short span of six months between January and June 23. The cases were followed up monthly for three months, and the diagnosis was made on a clinical, pathological, radiological, and histopathological basis. All the cases were managed with neck exploration and aggressive surgical debridement in an emergency department, dressing of the wound with hydrogen peroxide and betadine twice daily, triple broad-spectrum antibiotic therapy for polymicrobial infection, and tight glycemic control. There were no complications, and all the patients survived. We report our cases of cervical necrotizing fasciitis that had similar presentations but varied outcomes. Here, we would like to advocate the importance of immediate management in the form of neck exploration and debridement at the earliest after the diagnosis has been established. Hyperglycemia should be brought under control, and daily aseptic dressing with removal of the slough and source of infection would greatly affect the outcome of this deadly disease.
颈部坏死性筋膜炎是一种进展迅速、难以诊断的筋膜平面、皮肤及皮下组织的软组织感染。它具有显著的发病率和死亡率。在本病例报告中，我们分析了影响这种致命疾病预后的危险因素、实验室指标及治疗方式。这是一项回顾性病例系列研究，研究对象为在1月至6月23日这短短六个月内收治的病例。对这些病例进行了为期三个月的每月随访，并基于临床、病理、放射学及组织病理学做出诊断。所有病例均在急诊科接受颈部探查及积极的手术清创治疗，伤口每日用双氧水和碘伏换药两次，针对混合感染采用三联广谱抗生素治疗，并严格控制血糖。未出现并发症，所有患者均存活。我们报告了颈部坏死性筋膜炎病例，这些病例表现相似但预后各异。在此，我们倡导在确诊后尽早以颈部探查和清创的形式进行即刻处理的重要性。应控制高血糖，每日进行无菌换药以清除坏死组织及感染源，这将极大地影响这种致命疾病的预后。
