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• W1966092005 abstract "Sir: We congratulate Dr. Alexander Golger and colleagues on their very interesting publication in Plastic and Reconstructive Surgery.1 To our knowledge, this study has the largest sample of necrotizing fasciitis in the literature. It is interesting that perineal involvement was significant for a composite negative outcome (mortality rate of 30 percent). Other authors have shown better outcomes for patients with necrotizing fasciitis in this location.2 Craniocervical necrotizing fasciitis initially involves the superficial musculoaponeurotic system and superficial fascial planes of the head and neck, or it may result from a deep soft-tissue infection. Deep necrotizing fasciitis of the head and neck (Fig. 1) is a soft-tissue infection characterized by rapid progression and doubtful outcome, especially for some locations. Kantu and Har-El3 emphasized that necrotizing fasciitis of odontogenic origin has a mortality rate of 25 percent. Our review of necrotizing fasciitis after peritonsillar abscess found a mortality rate of 33 percent, which is substantially higher than that in other anatomical sites.4Fig. 1.: Intraoperative evaluation reveals deep necrotizing fasciitis of the neck.The mortality rate for cervical necrotizing fasciitis is higher than that for upper face and other infection sites because of the tendency for easy spread to the mediastinum, chest, and carotid sheath (Fig. 2).Fig. 2.: A computed tomography scan of the patient demonstrates diffuse infiltration of the anterior and left neck with drain position. Descending infection into the mediastinal space is a major complication of head and neck infections.In our review of necrotizing fasciitis after peritonsillar abscess,4 in 50 percent of patients (six of 12) the most commonly isolated organism was Streptococcus haemolyticus. Type II organisms were identified in 46 percent of patients in Golger et al.’s study,1 with predominant isolation sites being the head and neck and extremities. On the basis of their results, Golger et al.1 found that patients with group A Streptococcus infection tended to have excellent outcomes. The mortality rate for necrotizing fasciitis with type II organisms was 50 percent (three of six patients) in our review in comparison with 28 percent in Golger et al.’s publication. Also, it is interesting that the hyperbaric oxygen therapy group in Golger et al.’s study had a higher mortality rate in comparison with the nonhyperbaric oxygen therapy group (33 percent versus 18 percent), which was strongly associated with death (p = 0.037). Some recent reports do not support this finding5,6 and have found a better outcome and lower mortality rate in patients treated with hyperbaric oxygen therapy. Neven Skitarelic, M.D., Ph.D. Department of Otolaryngology Head and Neck Surgery Miro Morovic, M.D., Ph.D. Department of Infectious Disease Zadar General Hospital Zadar, Croatia" @default.
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• W1966092005 date "2008-03-01" @default.
• W1966092005 modified "2023-09-23" @default.
• W1966092005 title "Cervical Necrotizing Fasciitis" @default.
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• W1966092005 doi "https://doi.org/10.1097/01.prs.0000299640.11337.8d" @default.
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