Results
In total, 92 patients were admitted to hospitals across Greater Glasgow & Clyde with necrotising fasciitis from 2013-2021. Eight patients (10.4%) with head and neck NF were identified. The mean age of patients was 41 (median-43, range 1-81) years, see Table 1. Five out of 8 patients (63%) had features consistent with peri-orbital cellulitis on admission.
The average length of stay in hospital was 19.5 days (range-1-42 days). Patients, on average underwent 4 surgical procedures during their primary admission period (range 1-6). The average time to go to theatre after presentation to hospital was 9.75 hours (range 3-23 hours). All patients underwent surgical debridement and all were admitted to the intensive care unit post-operatively.
Average Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score on admission was 7. All patients had a raised C-reactive protein (CRP) on admission, with an average of 219 mg/L. Seven out of 8 patients had a leucocytosis on admission with an average value of 27.8 x10^9/L.
Six (75%) patients required subsequent reconstructive surgery. Three patients underwent soft tissue reconstruction to reconstruct peri-orbital defects, see figure 1 and 2. One patient underwent enucleation of the left eye with subsequent orbital implant insertion.
Six (75%) patients had evidence of isolated pan-sensitiveStreptococcus pyogenes in both pus and tissue samples. One patient had isolated mixed anaerobes, whilst another patient isolatedStreptococcus constellatus . Blood cultures grew no organism in 7 of 8 samples. Six of 8 (75%) histological specimens showed evidence of necrotising fasciitis.
Two patients had no predisposing factors/illnesses. One patient had an intercurrent Varicella Zoster infection. Two patients were active smokers (>10 cigarettes/day) and were taking regular inhaled corticosteroids. One patient had a history of previous alcohol dependence. Two patients had a diagnosis of psoriasis and had multiple courses of topical mild and potent corticosteroids. One patient had type 2 diabetes mellitus and was taking oral hypoglycaemic medication. One patient had been taking a long term non-steroidal inflammatory drug, namely diclofenac.