Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients

Abstract

Background Necrotising fasciitis is an uncommon but life-threatening soft tissue infection characterised by rapidly spreading inflammation and necrosis of skin, subcutaneous fat and fascia. Left untreated, the mortality can be more than 70%. Early surgical intervention can reduce morbidity and mortality. Patients and methods This is a series of 11 patients who presented to our oculoplastic and orbit unit with periocular necrotising fasciitis over a period of five years. We present the modes of presentation, predisposing factors, diagnosis, and the multidisciplinary team management of these patients. Results Of the 11 patients, 1 patient died and 2 patients required intensive care management. Of the 10 surviving patients, 8 patients needed further surgical interventions for correction of complications, like eyelid malposition, ptosis and protective or corrective surgery in the form of ectropion correction, skin grafting and other rehabilitative procedures. Conclusion To the best of our knowledge, this is the largest series of periocular necrotising fasciitis in the literature. Necrotising fasciitis is a potentially fatal condition, resulting in a high rate of mortality and morbidity. Early surgical intervention reduces the mortality. A high index of suspicion is needed to make a prompt diagnosis. These patients need expeditious intervention and may require a long follow-up and subsequent surgery for complications related to scarring and other sequelae.

Periocular necrotising fasciitis: a multicentre case series

“…As with NF at other sites, PONF is more common in men (68% this series; 17/23 (74%) in previous series3 5 8), which might be attributable to more frequent minor, contaminated skin trauma. The predilection of NF for minor trauma, rather than major injury, might occur because of the reduced ‘first-aid’ cleansing that occurs with minor injuries and the later subcutaneous sequestration of bacteria.…”

“…Notably—possibly because of a bias of case recall—smaller case series tend to report higher morbidity with septic shock in 4/7 patients (and one death) in one series and 1/11 death, and a further 1/11 unilateral visual loss through central retinal artery occlusion in another series 3 5…”

Modified Wound Closure Technique in Periorbital Necrotizing Fasciitis

“…[2][3][4][5][6][7]12 To date, these debridements have generally necessitated wide excision of necrotic tissue, leaving an open wound that is traditionally packed with a wound dressing. This report documents a novel wound closure technique in cases of periorbital necrotizing fasciitis and represents the first description of direct closure of the skin that overlies the underlying debrided planes.…”

“…1 When this disorder occurs in the ocular adnexa, necrotizing fasciitis carries a substantial risk of vision loss, cosmetic deformity, and mortality. [1][2][3][4][5][6][7] While some investigations have documented excellent outcomes with exclusive medical management, 8,9 extensive debridement with adjunctive intravenous antibiotic coverage remains the mainstay of care. [1][2][3] Borrowing from the general surgery literature, after extensive debridement, the defects associated with necrotizing fasciitis are generally covered with a sterile bandage and allowed to granulate.…”

Lidschwellung mit reduziertem Allgemeinzustand

“…Grundsätzlich kann diese Erkrankung in jeder Körperregion auftreten, besonders häufig sind die untere Extremität und der Körperstamm betroffen. Eine Beteiligung des Kopf-Hals-Bereichs oder eine okuläre Beteiligung sind selten [4,6].…”