Vacuum-Assisted Closure-Assisted Reconstruction of Extensive Anterior Cervical Necrotizing Fasciitis: A Case Report.

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection. While the extremities and trunk are most commonly affected, the anterior cervical region represents a rare site and poses additional risks due to its proximity to vital structures such as major vessels and the airway. Prompt diagnosis and aggressive management are critical for patient survival. We report a 44-year-old previously healthy male who presented with a one-week history of worsening anterior neck infection, pain, and tissue necrosis. Laboratory tests revealed elevated acute-phase reactants, and tissue cultures grew Klebsiella pneumoniae. Imaging demonstrated subcutaneous gas and fluid collections extending from the neck into the anterior chest wall. The patient underwent seven surgical procedures, including six sessions of serial debridement and split-thickness skin grafting harvested from bilateral femoral regions. The final procedures were followed by vacuum-assisted closure (VAC) therapy to control exudate and promote graft integration. After successful graft incorporation, adjunctive hyperbaric oxygen therapy was administered. With intensive care support, pathogen-targeted antibiotic therapy, repeated surgical debridements, and meticulous wound care, the patient achieved full recovery. At the one-year follow-up, he remained in good condition without complications. Anterior cervical NF, although rare and high-risk, can be successfully treated with early diagnosis, serial surgical debridement, skin grafting, VAC therapy, and adjunctive hyperbaric oxygen therapy. This case emphasizes the importance of multidisciplinary management in treating complex cervical wounds.