Cervical necrotizing fasciitis: negative pressure wound therapywith a reconstructive approach

Fascitis necrotizante cervical: terapia de presión negativa con enfoque reconstructivo

Introduction: necrotizing fasciitis is a fulminant infection with a low incidence rate of 0.4 cases per 100,000 people. It is characterized by rapid progression along the fasciae, causing vascular thrombosis and skin and adjacent tissue necrosis. Treatment consists of early and extensive debridement to prevent sepsis, which is responsible for the high mortality rate, although, this approach can leave significant soft tissue defects that may be managed utilizing negative pressure wound therapy (NPWT). NPWT helps remove necrotic tissue, stimulates angiogenesis and promotes tissue repair, facilitating definitive defect reconstruction with flaps. Case presentation: a patient presenting with necrotizing fasciitis of the neck and chest treated with aggressive surgical debridement followed by NPWT for soft tissue optimization for reconstruction with an ALT flap, achieving satisfactory functional and aesthetic results. Discussion: necrotizing fasciitis presents a diagnostic challenge due to its varied clinical manifestations. Early and adequate treatment is crucial for improving prognosis. NPWT is a valuable technique for managing this condition, especially to prepare a wound bed for reconstruction. It is contraindicated in the presence of cancer suspicion or exposed blood vessels. The reconstructive method selection, such as free flaps, depends on the size and location of the defect, as well as patient´s functional and aesthetic needs. Conclusions: the use of NPWT as part of the multidisciplinary management of necrotizing fasciitis of the face and neck can improve clinical outcomes, facilitating subsequent reconstruction and patient´s functional restoration.