Negative Pressure Wound Therapy: An Adjunct in Reconstructing Large Periocular Defects From Necrotizing Fasciitis

To demonstrate the use of negative pressure wound therapy (NPWT) and other reconstructive techniques in the reconstruction of large tissue defects resulting from periocular necrotizing fasciitis (NF).

Description of technique with 3 illustrative cases and accompanying photographic montage.

Technique : Debridement successfully spared post-septal tissues and the lid margin in all cases. Wounds were left open for several days until progressive infection was ruled out. NPWT was applied using hydrophobic, compressible open-pore polyurethane foam, and high-tensile polyvinyl alcohol foam to bolster the tarsorrhaphized eyelid and prevent exposure. A polyurethane, acrylic adhesive was applied overtop, and continuous vacuum at -75 mm Hg via a NPWT unit was applied for 4 to 14 days. Cases of NF included a 65-year-old woman with metastatic lung cancer, a 59-year-old man with diabetes, and a 57-year-old man with progressive preseptal cellulitis. In all cases, NPWT resulted in impressive macrodeformation and granulation of wounds, facilitating further repair using skin grafts, temporalis and orbicularis muscle flaps, and biodegradable temporizing matrix. Considering the initial extent of these wounds, all patients had excellent functional and aesthetic outcomes at 6 to 9 months, and no ophthalmic complications were observed.

In this series, NPWT was safe and effective in facilitating complex reconstruction of large periocular tissue defects resulting from necrotizing fasciitis.