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Periocular necrotising fasciitis--a case report
Cornelia Poitelea1, Michael J Wearne
1Department of Ophthalmology, Eastbourne District General Hospital, East Sussex, U.K. M.I.Poitelea@sussex.ac.uk
Orbit (Amsterdam, Netherlands)
|September 20, 2005
Summary
Necrotising fasciitis, a severe infection, can rapidly destroy facial tissues, including eyelids. This case details 12 months of reconstructive surgery to restore function and appearance after extensive periocular necrosis.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Infectious Disease
Background:
- Necrotising fasciitis is a rapidly progressive bacterial infection affecting deep fascia and subcutaneous tissue.
- Severe facial and periocular involvement presents a significant surgical challenge, often requiring extensive debridement and reconstruction.
Observation:
- A 68-year-old male presented with severe facial cellulitis and necrosis of all four eyelids following an insect bite.
- Initial management with broad-spectrum antibiotics failed to halt the progression of the necrotising fasciitis.
Findings:
- Surgical debridement removed necrotic tissue from forehead to mouth, followed by split-skin grafting for extensive defects.
- Subsequent reconstructive procedures included horizontal eyelid shortening and full-thickness skin grafts to correct ectropion, eyelid displacement, and lagophthalmos.
Implications:
- Successful reconstructive surgery over 12 months restored eyelid function and cosmesis in a challenging case of periocular necrotising fasciitis.
- This case highlights the importance of aggressive surgical management and staged reconstruction for severe necrotising infections of the face.