Cervical necrotizing fasciitis: Report of 6 cases and review of literature

Abstract

Concerning cervical necrotizing fasciitis, early diagnosis and surgical treatment associated to antibiotics and intensive medical care are essential to obtain a favorable outcome.

Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description

“…We did not find randomized controlled trials or clinical practice guidelines published on the diagnosis and treatment of descending necrotizing mediastinitis; the best available evidence in adults was obtained from 26 published studies of clinical reviews of 4 or more cases of descending necrotizing mediastinitis with evidence level III (Table ).…”

“…This study is the first systematic review of the treatment of descending necrotizing mediastinitis in the last 6 years, which includes a series of 4 or more cases published from 2009 to 2014, comparing mortality with the published revisions of earlier periods, which shows a decline since the year 2000, which has been sustained to this date (Table ).…”

“…Postoperative evaluation with CT is required in all patients at 48 to 72 hours, because not suspected collections were found in 59% of cases, it is imperative in cases with sepsis or without improvement (evidence level III).…”

“…Frequently, the need of reintervention (30%), on average, patients require 3.3 procedures (range, 1–6); although, in some reports, cases that require reintervention have higher mortality ( p = .01) and they represent advanced stages of the disease. A cohort study showed that when various transcervical ( p = .0001) and transthoracic ( p = .003) procedures were performed, they resulted in lower mortality rates than when fewer procedures were carried out ( p = .05), so we should not consider reoperation as treatment failure but as part of a serial treatment that improves survival (evidence level III).…”

“…Isolated case reports or series with less than 4 cases of descending necrotizing mediastinitis, which have low evidence level (IV), were not included for the purpose of analysis in this review. Reports of descending necrotizing mediastinitis published before the year 2009 were also not included because there are reviews of accumulated cases from the period from 1969 to 1989, from 1970 to 1997, and from 1998 to 2008, along with 5 meta‐analysis of these periods; all other case series published between 2009 to 2014 were included …”