Wong-Chew RM, Angel-Ambrocio AH, Gomez-Murillo SY, Puente-Sanchez A, Fernandez-Sobrino G, Marhx-Bracho A, Marroquín-Yañez MDL. Necrotizing fasciitis of the neck and head complicated with chronic osteomyelitis: Case report presentation.
Int J Surg Case Rep 2019;
59:220-223. [PMID:
30952495 PMCID:
PMC6599410 DOI:
10.1016/j.ijscr.2019.03.025]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022] Open
Abstract
Necrotizing fasciitis of the head and neck in children is very rare.
Proper early diagnosis and adequate antibiotic therapy played an important role.
Early aggressive surgical treatment is crucial for an adequate outcome.
The vacuum-assisted closure and hyperbaric oxygen therapy are very useful to accelerate wound healing.
A multidisciplinary management is fundamental to increase treatment success.
Introduction
Necrotizing fasciitis (NF) is a severe infectious condition associated with significant morbidity and mortality and characteristically has a higher incidence in adults; pediatric cases are very rare. In this case report we describe, the clinical presentation, management and outcome of a patient with necrotizing fasciitis of the neck and head complicated with chronic osteomyelitis.
Presentation of the case
An 18 month-old, latin, male, diagnosed with rickets and Crouzon syndrome, twenty-four hours post- craniofacial remodeling surgery presented tissue edema, indurated skin and violaceous and well delimited lesions in the neck and head. The patient developed septic shock, acute osteomyelitis and infection of the cranial grafts. Multiple surgical lavages, debridation of the necrotic tissue and resection of the affected bone, in combination with multiple antibiotics, laboratory test methods, VAC therapy and hyperbaric oxygen were required for successful treatment and full recovery of the patient.
Discussion
Although early antibiotic therapy and critical care are basic for the treatment of patients with NF, early aggressive surgical treatment is crucial for an adequate outcome. Adjuvant treatment for NF such as the Vacuum-assisted closure and the hyperbaric oxygen therapy are very useful to accelerate wound healing. Moreover, special laboratory test methods such as the checkerboard can be used to determine the adequate antimicrobial combination of drugs in the case of multi resistant organisms.
Conclusions
Early diagnosis, adequate antibiotic therapy and aggressive surgical debridement of the necrotic tissue combined with VAC and hyperbaric oxygen therapy played an important role in the successful treatment of NF.
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