(0688) Necrotizing Soft Tissue Infections of the Head and Neck: A Large Series Institutional Experience

Introduction: Necrotizing Soft Tissue Infections (NSTI) of the head and neck, including necrotizing fasciitis, are rare but dangerous infections that can progress quickly and result in significant morbidity and mortality. A variety of different disease patterns exist which can make prompt diagnosis and treatment difficult. Here we present one of the largest series of head and neck NSTI in order to improve understanding of this complex disease process.

Methods: Using electronic medical record search tools, patients treated surgically for NSTI involving the head and neck were identified between 2017 and 2024 a single tertiary care institution. Clinical characteristics, predisposing risk factors, surgical interventions, and hospital course were reviewed and analyzed.

Results: In total, 48 patients who had undergone treatment for necrotizing infection were identified. At least one predisposing factor (Diabetes, other immune compromise, radiation, IV drug use) was identified in 50% of cases. Of the cases, 46% were attributed to a cutaneous origin and Streptococcus species were the most commonly isolated organisms. Three patients (6%) developed the infection in a postoperative wound. Another 7 patients (15%) had extension to the mediastinum. Four patients (8%) died during the admission. Of the total, 51% of cases required intensive care and 28% required a tracheostomy during their course. The average number of operative debridements was 2.6 ranging from 1 to 15. Most patients (74%) underwent negative pressure wound therapy at some point.

Conclusions: NSTI represent a diverse group of dangerous infections and the varying patterns of presentation can make identification and successful management difficult. The large volume experience presented here provides helpful information regarding the possible clinical course of the disease and successful management strategies.