Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique: Two case reports

Abstract

BACKGROUND

Cervical necrotizing fasciitis (CNF) is a rare, aggressive form of deep neck space infection with significant morbidity and mortality rates. Serial surgical debridement acts as the cornerstone of CNF treatment; however, it often results in defects requiring complex reconstructions.

CASE SUMMARY

We report two cases in which the keystone flap (KF) was used for CNF defect coverage: Case 1, an 85-year-old patient with CNF in the anterior neck, and Case 2, a 54-year-old patient with CNF in the posterior neck. Both patients received empirical intravenous antibiotic therapy and underwent serial debridement, enabling adequate wound preparation and stabilization. The final defect size measured 5.5 cm × 12 cm in Case 1 and 6 cm × 11 cm in Case 2. For defect coverage, we employed an 8 cm × 19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm × 18 cm type II KF based on perforators from the transverse cervical artery in Case 2. Both flaps showed complete survival. No postoperative complications occurred in both cases, and favorable outcomes were observed at 7- and 6-month follow-ups in case 1 and 2, respectively.

CONCLUSION

We effectively treated CNF-associated defects using the KF technique; KF is viable for covering CNF defects in carefully selected cases.

Keywords: Fasciitis; Necrotizing; Debridement; Plastic surgery; Dermatologic surgical procedures; Case report

Core Tip: Cervical necrotizing fasciitis (CNF) is associated with rapid tissue destruction and mortality; hence, early diagnosis and prompt treatment are necessary. However, serial debridement of necrotic tissues often leads to defects that complicate reconstructions, necessitating the selection of an appropriate reconstruction method. This study, therefore, reports our experiences using the modified keystone flap (KF) technique for CNF defect coverage in two patients. The modified KF technique may serve as an effective reconstructive option for neck defects, owing to its reliable and favorable outcomes in selected cases with small- to moderate-sized defects.