Clinical parameters and challenges of managing cervicofacial necrotizing fasciitis in a Sub-Saharan tertiary hospital

Abstract

Introduction:Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF) in the University College Hospital, Ibadan.Materials and Methods:Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings.Results:Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844) cm. The mean hospital stay was 27.8 (±23.1) days, and scar formation was the most common complication encountered.Conclusion:Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.

Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es Salaam, Tanzania

“…Most of the available literature on cervicofacial NF is largely based on western countries where delay in seeking medical care, lack of personnel, self-prescription and poor nutrition are not common problems. Except for a few [4, 17, 18], the existing literature consists almost entirely of individual case reports and several small case series, which do not adequately permit reporting of patterns of presentation and management.…”

Cervical Necrotizing Fasciitis: A case report

“…11 The largest study from a single health center in Nigeria reported that there is a definite rise in prevalence of necrotizing fasciitis as they have seen a gradual increase to around 4 cases a year. 6 A systematic review conducted by Dhanasekana et al on necrotizing soft tissue infections from across the globe, found that the most common organisms involved are Staphylococcus aureus followed by Streptococcus pygenes and E. coli in North America, Asia, Middle East, and Africa. Interestingly, 16% of necrotizing soft tissue infections were accounted for by Methicillinresistant Staphylococcus aureus.…”

“…[2][3] It mainly affects those of immunocompromised and low socioeconomical status. [2][3][4][5][6] According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) it's estimated that 7 800 000 people in South Africa are living with Human Immunodeficiency Virus (HIV). 7 Due to the high prevalence of HIV in this population, knowledge and swift intervention of this condition is of importance .…”

Efficacity of hyperbaric oxygen therapy for necrotizing fasciitis in the maxillofacial region: The review of the literature

“…7 Reported predisposing factors for CNF include immunosuppression, diabetes mellitus, chronic illnesses, malnutrition, advanced age, renal insufficiency, malignancies, burns, arteriosclerosis, anaemia, smoking, alcoholism, obesity, hypothyroidism and drug use. 21 NF typically involves poly-microbial infections, with haemolytic Streptococcus A and Staphylococcus spp. being the most commonly isolated pathogens, alongside facultative aerobic and anaerobic bacteria.…”