Pupić-Bakrač Jure, Pupić-Bakrač Ana, Matoc Lovro, Kos Boris
Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Boze Pericica 5, Zadar, 23 000, Croatia.
Department of Ophthalmology, Dubrava University Hospital, Avenija Gojka Suska 6, Zagreb, 10 000, Croatia.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):519-528. doi: 10.1007/s00405-024-09015-y. Epub 2024 Oct 4.
Necrotizing fasciitis of the head and neck is a rare, rapidly progressing bacterial infection with high mortality. Traditional surgical management involves wide exposure incisions, but minimally invasive stab incisions have emerged as a potential alternative. This study aimed to compare outcomes between wide exposure and stab surgical incisions in the management of head and neck necrotizing fasciitis.
A retrospective analysis was conducted on 22 patients treated for necrotizing fasciitis of the head and neck between January 2006 and January 2023. Patients were divided into two groups based on the surgical approach: wide exposure incisions (N = 15) and stab surgical incisions (N = 7). Data on mortality, hospital stay, hypertrophic scarring, neck contractures, and tracheostomy tube dependence were collected.
The overall mortality rate was 9.1%, with 6.7% in the wide exposure group and 14.3% in the stab surgical incision group (p > 0.05). Hypertrophic scarring occurred in 59.1% of patients, all of whom underwent wide exposure incisions. Neck contractures were observed in 9.1% of cases, also in the wide exposure group. Tracheostomy was performed in 63.6% of patients, with successful decannulation achieved in 91.7%. The median hospital stay was longer in the stab surgical incision group (p < 0.05), partly due to the need for revision surgeries.
Wide exposure incisions remain the standard treatment for necrotizing fasciitis of the head and neck due to their effectiveness in managing extensive tissue necrosis. However, stab surgical incisions offer the advantage of reduced morbidity and functional impairment. These benefits are offset by a slightly higher mortality rate and the potential need for additional interventions. Stab incisions may be a viable option in carefully selected patients, particularly those without extensive comorbidities or advanced disease.
头颈部坏死性筋膜炎是一种罕见的、进展迅速的细菌感染，死亡率高。传统的手术治疗方法包括广泛切开暴露，但微创戳孔切口已成为一种潜在的替代方法。本研究旨在比较广泛切开暴露和戳孔手术切口在头颈部坏死性筋膜炎治疗中的效果。
对2006年1月至2023年1月期间接受头颈部坏死性筋膜炎治疗的22例患者进行回顾性分析。根据手术方式将患者分为两组：广泛切开暴露组（N = 15）和戳孔手术切口组（N = 7）。收集有关死亡率、住院时间、瘢痕增生、颈部挛缩和气管造口管依赖的数据。
总死亡率为9.1%，广泛切开暴露组为6.7%，戳孔手术切口组为14.3%（p > 0.05）。59.1%的患者出现瘢痕增生，所有这些患者均接受了广泛切开暴露手术。9.1%的病例观察到颈部挛缩，也在广泛切开暴露组中。63.6%的患者进行了气管造口术，91.7%成功拔管。戳孔手术切口组的中位住院时间较长（p < 0.05），部分原因是需要进行修复手术。
由于广泛切开暴露在处理广泛组织坏死方面的有效性，其仍然是头颈部坏死性筋膜炎的标准治疗方法。然而，戳孔手术切口具有发病率和功能障碍降低的优势。这些益处被略高的死亡率和潜在的额外干预需求所抵消。在精心挑选的患者中，特别是那些没有广泛合并症或晚期疾病的患者，戳孔切口可能是一个可行的选择。
