Pediatric necrotizing soft tissue infection after elective surgery: A case report and literature review.
INTRODUCTION
Necrotizing soft tissue infections (NSTIs) are rare but often lethal. Early diagnosis and aggressive surgical debridement are essential to achieve the best possible outcome.


CASE PRESENTATION
A 12-year old boy was diagnosed with a necrotizing soft tissue infection following elective revision surgery for functional impairment resulting from scar tissue of the neck. Fever and inflammation of the surgical wound manifested 24-36 hours postoperatively. Antibiotic therapy with amoxicillin-clavulanic acid was initiated, but the patient was unresponsive. Ultrasonography, a wound culture and surgical exploration confirmed the diagnosis. The culture was positive for a Streptococcus pyogenes infection and antibiotic treatment was switched to penicillin and clindamycin. Following the diagnosis, surgical debridement was performed subcutaneously, and only necrotic tissue was removed to preserve as much skin tissue as possible. After eradication of the infection, vacuum-assisted closure of the wound was used to close the subcutaneous space. The patient was discharged after 40 days.


CONCLUSION
In this patient, we treated a necrotizing soft tissue infection with antibiotics, skin sparing surgeries and negative pressure wound therapy (NPWT). We used ultrasonography as imaging technique to help with the diagnosis. The extensiveness of surgical debridement was rather limited. We focused on opening all affected fascial layers. The surgical debridement was subcutaneous, and only necrotic tissue was removed. Because of the location in the neck, we tried to avoid an aggressive skin debridement to preserve as much skin tissue as possible. Negative pressure wound therapy is not frequently used in this context but it contributed to an enhanced wound healing. Ultrasonography for diagnosing NSTIs is useful, but the clinical findings and an explorative surgery will remain most important.
['Gheuens|Lisa|L|', 'Roggeman|Quinten|Q|', 'Cortebeeck|Koen|K|', 'Leyman|Paul|P|', 'Bernaerts|Anja|A|', 'De Foer|Bert|B|', 'Van Leemput|Jan|J|', 'van Dinther|Joost|J|']
D019980:Amoxicillin-Potassium Clavulanate Combination D002648:Child D002921:Cicatrix D003646:Debridement D017558:Elective Surgical Procedures D019115:Fasciitis, Necrotizing D006801:Humans D008297:Male D054843:Negative-Pressure Wound Therapy D018461:Soft Tissue Infections D014945:Wound Healing
Pediatric Necrotizing soft tissue infections Surgical debridement Head and neck surgery