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.
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References
Bisno AL, Stevens DL . Streptococcal infections of the skin and soft tissues. N Engl J Med 1996; 334: 240–245.
Wilson B . Necrotising fasciitis. Am Surg 1952; 18: 416–431.
Shayegani A, MacFarlane D, Kazim M, Grossman ME . Streptococcal gangrene of the eyelids and orbit. Am J Ophthalmol 1995; 120: 784–792.
Hasham S, Matteucci P, Stanley PRW, Hart NB . Necrotising fasciitis. Br Med J 2005; 330: 830–833.
Sehgal VN, Sehgal N, Sehgal R, Khandpur S, Sharma S . Necrotising fasciitis. J Dermatolog Treat 2006; 17 (3): 184–186.
Legbo JN, Shehu BB . Necrotizing fasciitis: a comparative analysis of 56 cases. J Natl Med Assoc 2005; 97 (12): 1692–1697.
Young MH, Aronoff DM, Engleberg NC . Necrotizing fasciitis: pathogenesis and treatment. Expert Rev Anti Infect Ther 2005; 3 (2): 279–294.
Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO . Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003; 85-A (8): 1454–1460.
Vinh DC, Embli JM . Severe skin and soft tissue infections and associated critical illness. Curr Infect Dis Rep 2006; 8 (5): 375–383.
Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC et al Necrotising fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg 2002; 68: 109–116.
Kronish JW, McLeish WM . Eyelid necrosis and periorbital necrotizing fasciitis: report of a case and review of literature. Ophthalmology 1991; 98: 92–98.
Walters R . A fatal case of necrotizing fasciitis of the eyelid. Br J Ophthalmol 1988; 72: 428–431.
Rose GE, Howard DJ, Watts MR . Periorbital necrotizing fasciitis. Eye 1991; 5: 736–740.
Marshall DH, Jordan DR, Gilberg SM, Harvey J, Arthurs BP, Nerad J . Periocular necrotizing fasciitis: a review of five cases. Ophthalmology 1997; 104 (11): 1857–1862.
Gauzit R . Necrotizing skin and soft tissue infections: definitions, clinical and microbiological features. Ann Fr Anesth Reanim 2006; 25 (9): 960–970.
Low DE, McGeer A . Skin and soft tissue infection: necrotizing fasciitis. Curr Opin Infect Dis 1998; 11 (2): 119–123.
Pahlman LI, Morgelin M, Eckert J, Johansson L, Russell W, Riesbeck K et al. Streptococcal M protein: a multipotent and powerful inducer of inflammation. J Immunol 2006; 177 (2): 1221–1228.
Li DM, Lun LD, Chen XR . Necrotising fasciitis with Escherichia coli. Lancet Infect Dis 2006; 6 (7): 456.
Liu YM, Chi CY, Ho MW, Chen CM, Liao WC, Ho CM et al. Microbiology and factots affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 2005; 38 (6): 430–435.
Brittain CJ, Penwarden A, Mearza A, Verity D . Moraxella as a cause of necrotizing fasciitis of the eyelid. Eye 2006; 20 (11): 1312–1314.
Suner IJ, Meldrum ML, Johnson TE, Tse DT . Necrotizing fasciitis after cosmetic blepharoplasty. Am J OPhthalmol 1999; 128 (3): 367–368.
Ray AM, Bressler K, Davis RE, Gallo JF, Patete ML . Cervicofacial necrotizing fasciitis. A devastating complication of blepharoplasty. Arch Otolaryngol Head Neck Surg 1997; 123 (6): 633–636.
Jordan DR, Mawn L, Marshall DH . Necrotizing fasciitis caused by group A streptococcus infection after laser blepharoplasty. Am J Ophthalmol 1998; 125 (2): 265–266.
Elner VM, Demirci H, Nerad JA, Hassan AS . Periocular necrotizing fasciitis with visual loss, pathogenesis and treatment. Ophthalmology 2006; 113: 2338–2345.
Wong CH, Wang YS . The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 2005; 18 (2): 101–106.
Wong CH . The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32: 1535–1541.
Schmid MR, Kossmann T, Duewell S . Differentiation of necrotising fasciitis and cellulitis using MR imaging. Am J Roentgenol 1998; 170: 615–620.
Arslan A, Pierre-Jerome C, Borthne A . Necrotising fasciitis: unreliable MRI findings in the preoperative diagnosis. Eur J Radiol 2000; 36: 139–143.
Wyoski MG, Santora TA, Shah RM, Friedman AC . Necrotising fasciitis: CT characteristics. Radiology 1997; 203: 859–863.
Escobar SJ, Slade Jr JB, Hunt TK, Cianci P . Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing fasciitis reduces mortality and amputation rate. Undersea Hyperb Med 2005; 32 (6): 437–443.
Lazzeri D, Lazzeri S, Figus M, Agostini T, Nardi M, Pantaloni M . Hyperbaric oxygen therapy as further adjunctive therapy in the treatment of periorbital necrotizing fasciitis caused by group A Streptococcus. Ophthal Palst Reconstr Surg 2010; 26 (6): 504–505.
Aakalu VK, Sajja K, Cook JL, Ahmad AZ . Group A Streptococcal necrotizing fasciitis of the eyelids and face managed with debridement and adjunctive intravenous immunoglobulin. OPhthal Plast Reconstr Surg 2009; 25: 332–334.
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Tambe, K., Tripathi, A., Burns, J. et al. Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients. Eye 26, 463–467 (2012). https://doi.org/10.1038/eye.2011.241
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DOI: https://doi.org/10.1038/eye.2011.241
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