Pediatric head and neck necrotizing fasciitis in Somalia: surgical management, VAC utilization, and reconstructive outcomes

Pediatric head and neck necrotizing fasciitis is a rare, life-threatening infection requiring urgent surgical management. Evidence regarding vacuum-assisted closure (VAC) therapy and reconstructive outcomes remains limited. This study evaluated clinical characteristics, surgical management, VAC utilization, and outcomes in a pediatric cohort from Somalia. This retrospective single-center study included 40 children with surgically confirmed head and neck necrotizing fasciitis treated between January 2023 and April 2026. Clinical, microbiological, surgical, and reconstructive characteristics were evaluated. Exploratory comparisons were performed according to VAC utilization and reconstructive requirements. The mean age was 4.9 ± 2.3 years, and 60.0% were male. Deep neck involvement occurred in 32.5% and mediastinal extension in 7.5%. Repeated debridement was required in 42.5%, while VAC therapy was used in 11 patients (27.5%). Compared with non-VAC patients, VAC-treated patients had more frequent deep neck involvement (72.7% vs. 17.2%, p = 0.002), repeated debridement (81.8% vs. 27.6%, p = 0.003), and larger residual wound defects (69.4 vs. 16.5 cm², p < 0.001). Hospital stay was longer in the VAC group (29 vs. 10 days, p < 0.001). Definitive graft or flap reconstruction was required in 19 patients (47.5%), including all VAC-treated patients. Overall in-hospital mortality was 2.5%. Extensive cervical involvement and larger residual defects were associated with greater surgical and reconstructive requirements. VAC therapy was selectively used for complex wounds requiring staged reconstruction. These findings describe its clinical application but do not establish comparative effectiveness because of the retrospective design and confounding by indication.