PDF(Pubmed)
Abstract：
BACKGROUND: Cervical necrotizing fasciitis (CNF) is a rare, aggressive form of deep neck space infection with significant morbidity and mortality rates. Serial surgical debridement acts as the cornerstone of CNF treatment; however, it often results in defects requiring complex reconstructions.
METHODS: We report two cases in which the keystone flap (KF) was used for CNF defect coverage: Case 1, an 85-year-old patient with CNF in the anterior neck, and Case 2, a 54-year-old patient with CNF in the posterior neck. Both patients received empirical intravenous antibiotic therapy and underwent serial debridement, enabling adequate wound preparation and stabilization. The final defect size measured 5.5 cm × 12 cm in Case 1 and 6 cm × 11 cm in Case 2. For defect coverage, we employed an 8 cm × 19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm × 18 cm type II KF based on perforators from the transverse cervical artery in Case 2. Both flaps showed complete survival. No postoperative complications occurred in both cases, and favorable outcomes were observed at 7- and 6-month follow-ups in case 1 and 2, respectively.
CONCLUSIONS: We effectively treated CNF-associated defects using the KF technique; KF is viable for covering CNF defects in carefully selected cases.
METHODS: We report two cases in which the keystone flap (KF) was used for CNF defect coverage: Case 1, an 85-year-old patient with CNF in the anterior neck, and Case 2, a 54-year-old patient with CNF in the posterior neck. Both patients received empirical intravenous antibiotic therapy and underwent serial debridement, enabling adequate wound preparation and stabilization. The final defect size measured 5.5 cm × 12 cm in Case 1 and 6 cm × 11 cm in Case 2. For defect coverage, we employed an 8 cm × 19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm × 18 cm type II KF based on perforators from the transverse cervical artery in Case 2. Both flaps showed complete survival. No postoperative complications occurred in both cases, and favorable outcomes were observed at 7- and 6-month follow-ups in case 1 and 2, respectively.
CONCLUSIONS: We effectively treated CNF-associated defects using the KF technique; KF is viable for covering CNF defects in carefully selected cases.
摘要：
背景：宫颈坏死性筋膜炎（CNF）是一种罕见的，侵袭性形式的颈深间隙感染，具有显著的发病率和死亡率。连续手术清创是CNF治疗的基石；然而，它通常会导致需要复杂重建的缺陷。
方法：我们报告了两例使用梯形皮瓣（KF）覆盖CNF缺损的病例：病例1，一名85岁的前颈CNF患者，和病例2，一名54岁的后颈CNF患者。两名患者均接受经验性静脉抗生素治疗，并接受了连续清创术，使充分的伤口准备和稳定。最终缺陷尺寸在情况1中测量为5.5cm×12cm,在情况2中测量为6cm×11cm。对于缺陷覆盖，在病例1中，我们采用了基于甲状腺上动脉穿支的8cm×19cmII型KF，在病例2中，我们采用了基于颈横动脉穿支的9cm×18cmII型KF。两个皮瓣均显示完全存活。两组患者均未发生术后并发症,病例1和2分别在7个月和6个月的随访中观察到有利的结果。
结论：我们使用KF技术有效地治疗了CNF相关缺陷；在精心选择的病例中，KF可用于覆盖CNF缺陷。
方法：我们报告了两例使用梯形皮瓣（KF）覆盖CNF缺损的病例：病例1，一名85岁的前颈CNF患者，和病例2，一名54岁的后颈CNF患者。两名患者均接受经验性静脉抗生素治疗，并接受了连续清创术，使充分的伤口准备和稳定。最终缺陷尺寸在情况1中测量为5.5cm×12cm,在情况2中测量为6cm×11cm。对于缺陷覆盖，在病例1中，我们采用了基于甲状腺上动脉穿支的8cm×19cmII型KF，在病例2中，我们采用了基于颈横动脉穿支的9cm×18cmII型KF。两个皮瓣均显示完全存活。两组患者均未发生术后并发症,病例1和2分别在7个月和6个月的随访中观察到有利的结果。
结论：我们使用KF技术有效地治疗了CNF相关缺陷；在精心选择的病例中，KF可用于覆盖CNF缺陷。
