Abstract
Background
Necrotising fasciitis (NF) is a devastating disease with considerable mortality and morbidity, and early aggressive surgical debridement of devitalised necrotic tissues has traditionally been advocated.
Methods
We describe three patients who were referred from other units several weeks after developing periocular necrotising fasciitis; in all the three, the disease had been managed medically without surgical debridement, with apparent ‘stalling’ of the inflammatory process despite persistent necrotic periocular tissue.
Results
Following ‘elective debridement’ of the devitalised tissues and reconstruction with local flaps, all achieved a satisfactory aesthetic result.
Discussion
The role of host genetic determinants, polarised cytokine responses, and early, effective medical treatment in patients with atypical ‘disease phenotypes’ in NF are discussed.
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Acknowledgements
Mr Geoffrey Rose receives some funding from the Department of Health’s NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology.
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Mutamba, A., Verity, D. & Rose, G. ‘Stalled’ periocular necrotising fasciitis: early effective treatment or host genetic determinants?. Eye 27, 432–437 (2013). https://doi.org/10.1038/eye.2012.285
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DOI: https://doi.org/10.1038/eye.2012.285
