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).

Study Design: Case series with chart review.

Subjects and 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.

Conclusion: 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.