大胸筋皮弁による再建を要した頸部壊死性筋膜炎例

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  • Cervical Necrotizing Fasciitis Requiring Surgical Reconstruction Using Pectoralis Major Myocutaneous Flap
  • リンショウ ダイキョウキン ヒベン ニ ヨル サイケン オ ヨウシタ ケイブ エシセイ キンマクエンレイ

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In an immuno-compromised host with systematically disordered immuno-function, a mild infectious disease of the head and neck occasionally becomes severe, developing to cervical necrotizing fasciitis (CNF). We reported a case of CNF in a 74-year-old woman with chronic nephritis, who had been taking adrenocorticosteroids for about 20 years. Conservative therapy using intravenous antibiotic agents, based on the initial diagnoses of buccal cellulitis and acute tonsillitis, was ineffective for cheek and tonsil symptoms. Consequently, a large clot originating from tonsillar hemorrhage led to respiratory arrest after 6 days in hospital. Intensive medical care in the ICU improved her respiration and consciousness level. However, the progressive lesion of the cheek and tonsil, which was finally diagnosed as CNF and treated by surgical debridement, formed a large pharyngocutaneous fistula after 9 days in hospital. The pathogenic bacteria were Streptococcus milleni, Prevotella oris and Pseudomonas aeruginosa. Two weeks later, the pharyngocutaneous fistula was closed by reconstructive surgery using a pectoralis major myocutaneous (PMMC) flap, indicating that this flap is appropriate to reconstruct a large pharyngeal and cervical defect with a poor environment for wound healing because of the rich muscle volume and stability of local blood flow.

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