Case 1
A 43 year old female patient was admitted with ”neck pain for more than
10 days and shortness of breath for 1 day”. She had a history of type 2
diabetes for 15 years with poor control. The patient had panniculitis
for 13 years, stiffness of both hips and knees, and bedridden for 10
years. Speciality check-up: swelling of lateral neck and submandibular
area was obvious, tenderness was positive. After admission, emergency
neck CT showed: deep neck multi-space pneumatosis
(Figure. 3A), invasion of the upper
mediastinum (Figure. 3B). The diagnosis was necrotizing myofasciitis.
She underwent emergency ”tracheotomy + lateral neck incision and
exploration + drainage”. Intraoperative result showed necrosis of left
sternocleidomastoid muscle and deep cervical fascia (Figure. 3C). Dry
gauze was filled in the cavity for drainage after the necrotic tissue
was removed, and the balloon cannula was replaced (Figure. 3D). On the
first day after operation, an oxygen tube was placed in the pus cavity
with several side holes opened in the front of the oxygen tube (Figure.
3E). The oxygen flow was adjusted to 3L/min. this method was called
”pyogenic cavity aerobic therapy”. On the fifth day after operation,
when the pus was less or disappeared, the incision was sutured
intermittently. Two negative pressure drainage tubes were placed in the
operation cavity, one was placed in the parapharyngeal and
retropharyngeal space, and the other was placed in the upper mediastinum
(Figure. 3F). The suture was removed 14 days later, and the pus cavity
disappeared 24 days later (Figure. 3G). The drainage tube was removed
when the drainage fluid was clear (Figure. 3H), and the patient was
cured and discharged.