Craniofacial necrotizing fasciitis: reconstruction after radical surgery

An otherwise healthy 47-year-old male is described, he developed craniofacial necrotizing fasciitis of the scalp and face after having undergone dental extraction. Escherichia coli and coagulase-negative staphylococci were isolated from his wound cultures. Multiple debridement operations were necessary, with subsequent loss of his left eye and which resulted in severe mutilation. Both magnetic resonance imaging and computed tomography scanning helped to demonstrate the retrobulbar infection of his left eye. These were thus helpful to determine the extent of the disease and plan the course of surgery. Although we recognize that free flap surgery is the method of choice to cover this type of defect, we describe an alternative method of reconstruction. We have made multiple burr holes in the skull and used a low vacuum device to create a significant and viable layer of granulation tissue which was then covered with split skin grafts.