Cho W, Jang EA, Kim KN. Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique: Two case reports. World J Clin Cases 2024; 12(7): 1305-1312 [PMID: 38524511 DOI: 10.12998/wjcc.v12.i7.1305]
Corresponding Author of This Article
Kyu Nam Kim, MD, PhD, Full Professor, Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, No. 29 Saemunan-ro, Jongno-gu, Seoul 03181, South Korea. manabear77@naver.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2024; 12(7): 1305-1312 Published online Mar 6, 2024. doi: 10.12998/wjcc.v12.i7.1305
Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique: Two case reports
Wonseok Cho, Eun A Jang, Kyu Nam Kim
Wonseok Cho, Eun A Jang, Kyu Nam Kim, Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea
Author contributions: Cho W and Jang EA contributed equally to this work; Kim KN contributed to conceptualization and methodology, reviewed and edited the manuscript, and performed supervision; Jang EA contributed to software, provided resources and performed data curation; Kim KN and Cho W performed validation; Cho W performed formal analysis, and wrote the original draft; Cho W and Jang EA performed the research; Jang EA performed visualization. All authors have read and approve the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from all patients for the publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kyu Nam Kim, MD, PhD, Full Professor, Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, No. 29 Saemunan-ro, Jongno-gu, Seoul 03181, South Korea. manabear77@naver.com
Received: October 9, 2023 Peer-review started: October 9, 2023 First decision: January 12, 2024 Revised: January 25, 2024 Accepted: February 6, 2024 Article in press: February 6, 2024 Published online: March 6, 2024
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.
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.
