Necrotizing fascitis of the neck managenment with vacuum assisted therapy (VAC). Systematic review
Abstract Introduction and objective: Necrotizing fasciitis are life-threatening infections. A high index of suspicion is required for early diagnosis and management. Even if the treatment is adequate, surgical debridements leave large skin defects that are difficult to treat and control. VAC negative pressure systems allow for early healing of these tissue defects. Method: A systematic review was carried out in PubMed, EMBASE, Cochrane Library, Scopus, CIHAHL and Scielo, without language restriction, including all articles published until July 31, 2023. Results: 11 original studies met the inclusion criteria (10 case reports and 1 case series), with a total of 18 patients with cervical fasciitis treated with VAC. A higher prevalence is shown in men, the main comorbidity is diabetes mellitus and the main origin is odontogenic. 100% of patients require surgical debridement, the average use of VAC is 25.7 days and none of the patients studied died. Discussion: The presentation of necrotizing fasciitis in the head and neck is rare, it associates an inflammatory response that requires multidisciplinary treatment. VAC helps promote healing by reducing the bacterial load, reduces the number of debridements, and shortens hospital stay. Conclusions: Negative pressure therapy has been shown to be an effective and safe therapeutic option for the treatment of necrotizing fasciitis in other regions. We consider that conducting a regulated study on its use at the cervical level could provide scientific evidence in favor of its use.
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Hua C, Urbina T, Bosc R, Parks T, Sriskandan S, de Prost N, et al. Necrotising soft-tissue infections. Lancet Infect Dis. 2023;23:81–94.
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344–362.
Daszenies CS, Rahal ME, Arregui R V. Fascitis necrotizante de cuello. Rev. Otorrinolaringol. Cir. Cabeza Cuello. 2004;64:247-251.
Martínez AY, McHenry CR, Meneses Rivadeneira L. Fasceítis necrosante cervicofacial: Una infección severa que requiere tratamiento quirúrgico temprano. Rev Esp Cir Oral Maxilofac. 2016;38(1):23–28.
Silberstein J, Grabowski J, Parsons JK. Use of a Vacuum-Assisted Device for Fournier’s Gangrene: A New Paradigm. Reviews in urology. 2008;10(1):76-80.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Rev Esp Cardiol. 2021;74(9):790–799.
Balcı MK, Ciğer E, Arslanoğlu S, İşlek A. Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy. European Archives of Oto-Rhino-Laryngology. 2018;275(10):2555–2562.
Del-Salvador H, Barros-Luco-Trudeau H, Barría TE, Abarca AS, Cancino MC, et al. Fasceítis necrotizante cervical: Consideraciones para el manejo precoz. Rev. Otorrinolaringol. Cir. Cabeza Cuello. 2018;78(3):294-299.
Rodríguez R, Belizario M, Coca R, Bermúdez L, Reyes BR, Mena A. Fascitis necrotizante cervicofacial de origen odontogénico. Acta Médica del Centro. 2022;16(4):715-723.
Al-Zahid S, Izadi D, Day CJ, Wilson A, Stone C, Smith J. A novel airway management strategy for cervical necrotising fasciitis secondary to Bezold’s abscess. Ann R Coll Surg Engl. 2018;101:23-25.
Novelli G, Catanzaro S, Canzi G, Sozzi G, Bozzetti A. Vacuum assisted closure therapy in the management of cervico-facial necrotizing fasciitis: a case report and review of the literatura. Minerva Stomatol. 2014;63:135-144.
Sandner A, Moritz S, Unverzagt S, Plontke SK, Metz D. Cervical necrotizing fasciitis - The value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an indicative parameter. J Oral Maxillofac Surg. 2015;73(12):2319–2333.
Zhou EH, Liu SR, Zhu HM, Yi HL, Chen XP. Management and postoperative use of double-cannula irrigation–drainage tube in cervical necrotizing fasciitis: a Chinese single-institution experience of 46 patients. Eur Arch Otorhinolaryngol. 2021;278(8):2975–2981.
Campana VL, Braun FM, Giuliani C. Cervical necrotizing fasciitis by dental abscess treated with negative pressure wound therapy: Case report. Int J Surg Case Rep. 2020;77:795–798.
O’Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis. 2007;45(7):853–862.
Lee JH, Foo FJ, Wong AWJ. Posterior cervical necrotising fasciitis: a multidisciplinary endeavour in surgery. J Surg Case Rep. 2023;3:1-3.
Stevens DL, Baddour LM. Necrotizing soft tissue infections. UpToDate, Shefner JM (Ed), UpToDate, Waltham, MA. 2023.
Ouazzani A, Dequanter D, Buttafuoco F, Raynal P, Lothaire. Cervical necrotizing fasciitis arising from dental abscess: a rare clinical observation. Rev Med Brux. 2009;30:99-105.
Parra P, Pérez S, Patiño ME, Castañeda S, García JA. Actualización en fascitis necrotizante. Semin Fund Reumatol. 2012;13:41–48.
Zhang R, Zhang Y, Hou L, Yan C. Vacuum-assisted closure versus conventional dressing in necrotizing fasciitis: a systematic review and meta-analysis. J Orthop Res. 2023;18(85):1-9.
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–1541.
Oczenski W, Waldenberger F, Nehrer G, Kneifel W, Swoboda H, Schwarz S, et al. Vacuum-assisted closure for the treatment of cervical and mediastinal necrotizing fasciitis. J Cardiothorac Vasc Anesth. 2004;18(3):336–338.
Muhammad JK, Almadani H, Al Hashemi BA, Liaqat M. The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. J Oral Maxillofac Surg. 2015;73(5):918–927.
Chen SJ, Ji N, Chen YX, Zhao SJ, Xiao JR, Lin XM, et al. Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases. Br J Oral Maxillof Surg. 2015;53(7):642–646.
Sukato DC, Ferzli G, Thakkar P, Gordin E. Concurrent external and intraluminal vacuum-assisted closure in head and neck necrotizing fasciitis. Laryngoscope. 2017;127(6):1361–1364.
Brox-Jiménez A, Díaz-Gómez D, Parra-Membrives P, Martínez-Baena D, Márquez-Muñoz M, Lorente-Herce J, et al. A vacuum assisted closure system in complex wounds: A retrospective study. Cir Esp. 2010;87(5):312–317.
Vowden K, Téot L, Vowden P. Elección del tratamiento con presión negativa tópica en la práctica. La presión negativa tópica en el tratamiento de heridas.2007;(7):10-14.
Govea-Camacho LH, Astudillo-Carrera A, Hermosillo-Sandoval JM, Rodríguez-Reynoso S, González-Ojeda A, Fuentes-Orozco C. Impacto del manejo con cierre asistido al vacío en abscesos profundos de cuello. Cir Cir. 2016;84(4):275–281.
Choi HJ. Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty. J Craniofac Surg. 2014;25(5):507–509.
Frankel JK, Rezaee RP, Harvey DJ, McBeath ER, Zender CA, Lavertu P. Use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis. Head Neck. 2015;37(11):157–160.
Tang ATM, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg. 2000;17:482-484.
Dosluoglu HH, Schimpf DK, Schultz R, Cherr GS. Preservation of infected and exposed vascular grafts using vacuum assisted closure without muscle flap coverage. J Vasc Surg. 2005;42(5):989–992.
Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database Syst Rev. 2025;1(1).
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344–362.
Daszenies CS, Rahal ME, Arregui R V. Fascitis necrotizante de cuello. Rev. Otorrinolaringol. Cir. Cabeza Cuello. 2004;64:247-251.
Martínez AY, McHenry CR, Meneses Rivadeneira L. Fasceítis necrosante cervicofacial: Una infección severa que requiere tratamiento quirúrgico temprano. Rev Esp Cir Oral Maxilofac. 2016;38(1):23–28.
Silberstein J, Grabowski J, Parsons JK. Use of a Vacuum-Assisted Device for Fournier’s Gangrene: A New Paradigm. Reviews in urology. 2008;10(1):76-80.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Rev Esp Cardiol. 2021;74(9):790–799.
Balcı MK, Ciğer E, Arslanoğlu S, İşlek A. Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy. European Archives of Oto-Rhino-Laryngology. 2018;275(10):2555–2562.
Del-Salvador H, Barros-Luco-Trudeau H, Barría TE, Abarca AS, Cancino MC, et al. Fasceítis necrotizante cervical: Consideraciones para el manejo precoz. Rev. Otorrinolaringol. Cir. Cabeza Cuello. 2018;78(3):294-299.
Rodríguez R, Belizario M, Coca R, Bermúdez L, Reyes BR, Mena A. Fascitis necrotizante cervicofacial de origen odontogénico. Acta Médica del Centro. 2022;16(4):715-723.
Al-Zahid S, Izadi D, Day CJ, Wilson A, Stone C, Smith J. A novel airway management strategy for cervical necrotising fasciitis secondary to Bezold’s abscess. Ann R Coll Surg Engl. 2018;101:23-25.
Novelli G, Catanzaro S, Canzi G, Sozzi G, Bozzetti A. Vacuum assisted closure therapy in the management of cervico-facial necrotizing fasciitis: a case report and review of the literatura. Minerva Stomatol. 2014;63:135-144.
Sandner A, Moritz S, Unverzagt S, Plontke SK, Metz D. Cervical necrotizing fasciitis - The value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an indicative parameter. J Oral Maxillofac Surg. 2015;73(12):2319–2333.
Zhou EH, Liu SR, Zhu HM, Yi HL, Chen XP. Management and postoperative use of double-cannula irrigation–drainage tube in cervical necrotizing fasciitis: a Chinese single-institution experience of 46 patients. Eur Arch Otorhinolaryngol. 2021;278(8):2975–2981.
Campana VL, Braun FM, Giuliani C. Cervical necrotizing fasciitis by dental abscess treated with negative pressure wound therapy: Case report. Int J Surg Case Rep. 2020;77:795–798.
O’Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis. 2007;45(7):853–862.
Lee JH, Foo FJ, Wong AWJ. Posterior cervical necrotising fasciitis: a multidisciplinary endeavour in surgery. J Surg Case Rep. 2023;3:1-3.
Stevens DL, Baddour LM. Necrotizing soft tissue infections. UpToDate, Shefner JM (Ed), UpToDate, Waltham, MA. 2023.
Ouazzani A, Dequanter D, Buttafuoco F, Raynal P, Lothaire. Cervical necrotizing fasciitis arising from dental abscess: a rare clinical observation. Rev Med Brux. 2009;30:99-105.
Parra P, Pérez S, Patiño ME, Castañeda S, García JA. Actualización en fascitis necrotizante. Semin Fund Reumatol. 2012;13:41–48.
Zhang R, Zhang Y, Hou L, Yan C. Vacuum-assisted closure versus conventional dressing in necrotizing fasciitis: a systematic review and meta-analysis. J Orthop Res. 2023;18(85):1-9.
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–1541.
Oczenski W, Waldenberger F, Nehrer G, Kneifel W, Swoboda H, Schwarz S, et al. Vacuum-assisted closure for the treatment of cervical and mediastinal necrotizing fasciitis. J Cardiothorac Vasc Anesth. 2004;18(3):336–338.
Muhammad JK, Almadani H, Al Hashemi BA, Liaqat M. The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. J Oral Maxillofac Surg. 2015;73(5):918–927.
Chen SJ, Ji N, Chen YX, Zhao SJ, Xiao JR, Lin XM, et al. Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases. Br J Oral Maxillof Surg. 2015;53(7):642–646.
Sukato DC, Ferzli G, Thakkar P, Gordin E. Concurrent external and intraluminal vacuum-assisted closure in head and neck necrotizing fasciitis. Laryngoscope. 2017;127(6):1361–1364.
Brox-Jiménez A, Díaz-Gómez D, Parra-Membrives P, Martínez-Baena D, Márquez-Muñoz M, Lorente-Herce J, et al. A vacuum assisted closure system in complex wounds: A retrospective study. Cir Esp. 2010;87(5):312–317.
Vowden K, Téot L, Vowden P. Elección del tratamiento con presión negativa tópica en la práctica. La presión negativa tópica en el tratamiento de heridas.2007;(7):10-14.
Govea-Camacho LH, Astudillo-Carrera A, Hermosillo-Sandoval JM, Rodríguez-Reynoso S, González-Ojeda A, Fuentes-Orozco C. Impacto del manejo con cierre asistido al vacío en abscesos profundos de cuello. Cir Cir. 2016;84(4):275–281.
Choi HJ. Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty. J Craniofac Surg. 2014;25(5):507–509.
Frankel JK, Rezaee RP, Harvey DJ, McBeath ER, Zender CA, Lavertu P. Use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis. Head Neck. 2015;37(11):157–160.
Tang ATM, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg. 2000;17:482-484.
Dosluoglu HH, Schimpf DK, Schultz R, Cherr GS. Preservation of infected and exposed vascular grafts using vacuum assisted closure without muscle flap coverage. J Vasc Surg. 2005;42(5):989–992.
Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database Syst Rev. 2025;1(1).
Rodríguez-Rodríguez, D., Sanz-Sánchez, C. I., & Cazorla-Ramos, Óscar E. (2024). Necrotizing fascitis of the neck managenment with vacuum assisted therapy (VAC). Systematic review. Revista ORL, e31996. https://doi.org/10.14201/orl.31996
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