Reconstruction of a huge oral maxillofacial defect caused by necrotic fasciitis secondary to leukaemia

SummaryAn 8-year-old boy who was diagnosed with ‘acute non-lymphoblastic leukaemia (M2)’, contracted secondary oral maxillofacial necrotic fasciitis. The wound was cleaned with 3% hypertonic saline, and then covered with iodoform gauze every day for about 3 weeks before and after necrotic tissue debridement. The local infection was controlled, and plenty of new healthy granular tissue had grown. The patient was left with a huge defect including the mouth floor, submental area, submandibular area and right cheek when the necrotic tissue was removed. Reconstruction of the defect was very difficult because of the patient's pre-existing leukaemia condition and severe inflammatory local condition. We successfully reconstructed the defect by using the new healthy granular tissue and a trapezius myocutaneous flap. During 9 years of follow up, in order to improve quality of life, the patient underwent scar modification surgery and orthodontic treatment, and facial appearance and oral functions were deemed satisfactory.