Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis.
OBJECTIVE
To review our management of cervical necrotizing fasciitis (CNF) with the use of adjunctive hyperbaric oxygen therapy (HBO).


METHODS
Case series with chart review.


METHODS
Evaluation of ten patients with CNF between 2001 to 2006.


RESULTS
There were five male and six female patients. Mean age was 43 +/- 11 years. Eight cases resulted from an odontogenic source. Comorbidities included diabetes mellitus, hypertension, and substance abuse. All patients had computed tomography scans performed, received intravenous antibiotics, and underwent surgical debridement. Eight patients underwent surgery within 24 hours. The average number of debridements was 2.2 +/- 0.8. Hospitalization was twice as long for diabetic patients (15.5 +/- 8.16 days) compared with nondiabetic patients (7.5 +/- 1.6 days, P = 0.029). Nine patients had HBO therapy. Combined data revealed a possible decrease in length of hospitalization with HBO therapy (P < 0.001). No mortality was documented.


CONCLUSIONS
In addition to early and aggressive medical management and surgical debridement, this study suggests that HBO therapy is a beneficial adjunct by potentially decreasing length of hospitalization. Randomized trials are still needed to demonstrate its efficacy.
Flanagan
Carrie E
CE
University of Minnesota Medical School, Hennepin County Medical Center, Minneapolis, MN, USA. ceflan3@comcast.net
Daramola
Opeyemi O
OO
Maisel
Robert H
RH
Adkinson
Cher
C
Odland
Rick M
RM
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003646:Debridement / Q000379:methods*; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D005491:Focal Infection, Dental / Q000150:complications; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents