Craniocervical necrotizing fasciitis with and without thoracic extension: management strategies and outcome.
OBJECTIVE
First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors.


METHODS
Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension.


RESULTS
Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived.


CONCLUSIONS
This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.
Mao
Johnny C
JC
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA. jmao@med.wayne.edu
Carron
Michael A
MA
Fountain
Kimberly R
KR
Stachler
Robert J
RJ
Yoo
George H
GH
Mathog
Robert H
RH
Coticchia
James M
JM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006257:Head; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009333:Neck; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013896:Thoracic Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D013907:Thoracostomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents