Necrotizing fasciitis of the periorbital region: from presentation to reconstructive journey
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CASE REPORT
Necrotizing fasciitis of the periorbital region: from presentation to reconstructive journey Shameem A. Haque 1
&
Andreas Georgiou 1 & Hugo Henderson 2 & Alexander Woollard 1
Received: 7 June 2020 / Accepted: 9 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Periorbital necrotizing fasciitis is a very rare condition with a UK incidence of 0.24 cases per million per annum. Outcomes can range from disfigurement to sight loss and even death. Debridement is crucial when sight or life is threatened and the subsequent reconstructive stages can be challenging. We describe two cases of periocular necrotizing fasciitis demonstrating the progression of the disease as well as the surgical debridement for both pre-septal and post-septal disease and the reconstructive steps leading to outcome. Level of evidence: Level V, therapeutic study. Keywords Periorbital necrotizing fasciitis . Orbital necrotizing fasciitis . Debridement . Eyelid reconstruction . Pre-septal . Post-septal
Introduction
Case 1
Periorbital necrotizing fasciitis is a very rare condition with a UK incidence of 0.24 cases per million per annum [1]. Outcomes can range from disfigurement to sight loss in 14%. Risk of death is 3%, much lower than other sites where death can occur in up to 35% [2]. This is attributed to the earlier presentation, the rich blood supply allowing better antibiotic penetration, and also the orbital septum which provides a barrier to posterior spread [3]. The mainstay of treatment is multidisciplinary, involving infectious diseases, intensivists, plastic surgery, and ophthalmology. Emergency debridement is crucial when sight or life is threatened and the subsequent reconstructive stages can be challenging. We describe two cases of periocular necrotizing fasciitis demonstrating the progression of the disease as well as the reconstructive steps and outcome.
This was a 68-year-old lady who presented with periocular necrotizing fasciitis following an episode of dermatitis, a reaction to a shampoo. She took serial selfies which demonstrated progression from a superficial dermatitis to orbital involvement (Figs.1, 2, and 3). On day 10, she presented to hospital with orbital pain. Even though she was afebrile (36.7 °C), she had significant proptosis with pus discharging from her eye (Fig. 4). WCC was 12.82 × 109/L; CRP was 308 mg/L. She was started on tazocin, clindamycin, and piptazocin. CT scans showed extensive soft tissue thickening anterior to the right orbit with central abscess formation. Within the orbit, there was a collection at the superolateral aspect extending to the nasal side. She underwent immediate decompression. Intraoperatively, pus was found in both her upper and lower
* Shameem A. Haque [email protected] 1
Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW32QG, UK
2
Department of Ophthalmology, Royal Free Hospital, London, UK
Fig. 1 Initial reaction in periorbital area showing dermatitis on day 2
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