The Challenges of Extensive Face and Neck Necrotising Fasciitis Reconstruction: A Case Report

Necrotising fasciitis (NF) is a rare, severe, rapidly progressive, and life-threatening synergistic infection that primarily affects the superficial fascia. Although unusual in head and neck surgeries, necrotizing fasciitis may have drastic consequences. Dental problems, burns, trauma, and peritonsillar abscesses often cause the condition. We describe a rare case of extensive facial necrotising fasciitis secondary to carbimazole-induced agranulocytosis. A protective tracheostomy, prophylactic thyroidectomy, serial surgical debridement, and broad-spectrum antibiotics therapy were initiated. Our team referred the patient for subsequent soft tissue reconstruction. Reconstruction was challenging as it involved a full-thickness cheek defect extending to the oral commissure, lower lip, and anterior neck. In a single-stage procedure, we utilised a transverse upper gracilis free flap to reconstruct full-thickness tissue loss, provide tissue bulk, and seal the dead space. Reconstructing various parts of the face and lips while ensuring aesthetic and functional results can be difficult..