頸部壊死性筋膜炎の4例

抄録

Among soft tissue infections of the neck, necrotizing fasciitis is relatively more likely to lead to serious outcomes due to the prolonged course, and prompt treatment is required. We encountered 4 cases of cervical necrotizing fasciitis in 3 months. The patients consisted of 3 males and 1 female, and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 1 in the low-risk group, 1 in the moderate-risk group, and 2 in the high-risk group. Among the patients, the low-risk group patients showed abscess formation in the longitudinal direction over time and required surgical treatment. In addition, some cases required plastic surgery at a university hospital due to inadequate wound healing associated with the underlying disease, and cases in which the surgical procedure could not be completed due to the underlying disease had unfortunate outcomes. Early antimicrobial administration and extensive necrotic tissue removal by debridement were required in all the cases. Age and presence/absence of the underlying disorder also influenced the course of the condition. Although the LRINEC score is useful for risk assessment in patients with cervical necrotizing fasciitis, it has been reported that the cervical necrotizing fascia inflammation spreads in the longitudinal direction in about a half of the cases. Our clinical experience underscored to us the importance of monitoring the course of the subjective symptoms and multiple blood test results, and image evaluations.