Effective Treatment Using Negative Pressure Wound Therapy for Necrotizing Fasciitis of Scalp Originating from Odontogenic Infection

Abstract

Necrotizing fasciitis is an uncommon but life-threatening infectious disease. In this report, we describe the cases of two patients who presented with an extremely rare necrotizing fasciitis of the scalp, originating from an odontogenic infection, and who were treated successfully with negative pressure wound therapy (NPWT). Both patients had diabetes mellitus and were admitted to the emergency department. Facial computed tomography revealed multifocal fluid collection, soft tissue swelling, and thickening from the perioral region to the scalp. Extensive incision, drainage, and debridement were performed. Taking into account the pain the patients were suffering and their general condition, NPWT was then applied instead of a povidone iodine-soaked dressing. With appropriate antibiotics, serial surgical debridement, and NPWT, the infection was controlled within a month from the first session of NPWT. For wound closure, one patient underwent primary closure and split thickness skin grafting with bone decortication, and the other patient underwent only primary closure. Although necrotizing fasciitis is associated with high morbidity and mortality, both patients’ general conditions improved, and their surgical wounds healed successfully. NPWT can be a safe, effective treatment for necrotizing fasciitis of the head and neck, and it can reduce both patients’ pain and physicians’ effort.