Vacuum-assisted closure for the treatment of cervical and mediastinal necrotizing fasciitis

NECROTIZING FASCIITIS is a rare but life-threatening infection of the soft tissue that is characterized by widespread fascial necrosis sparing the skin and the underlying muscle. The clinical course is often characterized by a severe hyperacute sepsis and a very high mortality rate of up to 70%.(1-3) Localization in the neck is rare and usually occurs secondary to dental, pharyngeal, and tonsillar infections. Crucial in treatment is the early recognition of the disease and immediate aggressive surgical treatment.(4) The course of the disease is often complicated by the great amount of necrotic tissue causing infection and mutilation. The authors report a case of cervical necrotizing fasciitis arising from a peritonsillar abscess complicated by severe mediastinitis and septic shock and, for the first time in this context, the successful use of a vacuum-assisted closure technique as an adjunctive wound treatment.