Modified Usage of Negative Pressure Wound Therapy for the Management of Severe Deep Fascial Space Infections in the Head and Neck

Figures & data

Figure 1 The latex drainage tubes were inserted into the wound. Note that the red lines indicate the direction and depth of the latex side-holed drainage tubes, some of which were pulled through the dissected pathway to form a through-and-through drain.

Figure 2 The foam materials were cut into bar-shaped pieces and inserted into the wound along with the latex drainage tubes. Note that the blue lines indicate the direction and depth of the foam.

Figure 3 The bar-shaped foam materials were connected by a block of foam dressing on the surface of the face and neck. Sutures were sometimes needed to stabilize the foam block.

Figure 4 After the application of the film, an adhesive disc and drainage tube were connected to the foam dressing with a pressure-controlled vacuum source.

Figure 5 The drainage was efficient and the container of the NPWT device needed to be replaced once it was almost full.

Table 1 The Demographics and Clinical Characteristics of the Patients

Patient No.	Sex	Age (Years)	Source of Infection	Associated Diseases	Involved Spaces	Bacterial Findings
1	Female	57	Odontogenic	Diabetes mellitus	Submandibular, submental, buccal, deep temporal, superficial temporal, pterygomandibular, submasseteric, lateral pharyngeal	Streptococcus viridans
2	Male	46	Odontogenic	–	Submandibular, buccal, pterygomandibular, submasseteric, lateral pharyngeal	–
3	Male	59	Tonsil	–	Submandibular, sublingual, submental, lateral pharyngeal, pretracheal	Streptococcus viridans
4	Male	68	Odontogenic	Rheumatoid arthritis and prednisone history	Sublingual, submental, deep temporal, pterygomandibular, lateral pharyngeal, pretracheal	Streptococcus pneumoniae
5	Female	79	Odontogenic	Diabetes mellitus	Submandibular, deep temporal, superficial temporal, pterygomandibular, submasseteric, lateral pharyngeal	Streptococcus viridans
6	Female	72	Odontogenic	–	Sublingual, submental, lateral pharyngeal, pretracheal	Streptococcus viridans
7	Male	75	Odontogenic	–	Submandibular, submasseteric, lateral pharyngeal	Staphylococcus aureus
8	Male	35	Odontogenic	–	Submandibular, submental, lateral pharyngeal	Streptococcus hemolyticus
9	Male	73	Tonsil	Diabetes mellitus	Buccal, submandibular, submental, deep temporal, submasseteric, lateral pharyngeal	–
10	Female	65	Odontogenic	–	Submandibular, sublingual, submental, submasseteric, lateral pharyngeal,	Staphylococcus aureus
11	Female	68	Odontogenic	–	Submandibular, sublingual, submental, pterygomandibular, lateral pharyngeal, pretracheal	Streptococcus hemolyticus
12	Male	56	Odontogenic	–	Sublingual, submental, lateral pharyngeal, pretracheal	–

Figure 6 This patient recovered 4 days after the removal of the NPWT device, leaving the scars to be corrected later.

Figure 7 Scatter plot of the time of removal of NPWT, administration of antibiotics, and complete wound healing of all 12 patients. The median time and range are indicated.