Healing of cervical necrotizing fasciitis using amniotic membrane as a dressing material

Early recognition, aggressive surgical debridement, removal of cause, appropriate antibiotic therapy, improvement of immunocompromised state and dressing of the wound is the treatment of necrotizing cervical fasciitis. There are so many reported cases of burn and some reported cases of necrotizing fasciitis where amniotic membrane has been used as a dressing material, and that encouraged us to use it as a dressing material in our cases.

Six cases of necrotizing cervical fasciitis reported to our department in a span of five years (2005 to 2010). Amniotic membrane taken from placenta of suitable donors had been used as a dressing material in these cases. Data collection included age, sex, medical history of the patients, size of the wound, pain felt by the patient, time taken for granulation tissue formation, total healing time, size of the scar and need for future reconstruction.

The sample consisted of six patients with a mean age of 45 years. Four of them were male. Etiology was always odontogenic. Five patients were immunocompromised. Three patients were chronic alcoholic. Average size of the wound was 42 square centimeter. Mean time taken for formation of granulation tissue was 22 days; mean total healing time was 36 days. In every case patient reported with pain, which gradually diminished after first application of amniotic membrane. In three cases, pain on fourth day after first application of amniotic membrane was nil (VAS scale). In rest three cases, pain on sixth day after first application of amniotic membrane was nil (VAS scale). Average size of the scar was 9 cm(2). Secondary scar revision was required in all six cases.

Our study concludes that amniotic membrane can be used effectively as a dressing material in necrotizing cervical fasciitis.