Periocular necrotising fasciitis--a case report.
OBJECTIVE
To document the step-by-step reconstructive surgical rehabilitation, over a 12-month period, of a patient with severe periocular necrotising fasciitis.


METHODS
This is a retrospective interventional case note review of a 68-year-old man who developed necrotising fasciitis a few days after an insect bite. He had severe facial cellulitis with subsequent necrosis of all four eyelids despite broad spectrum antibiotics.


RESULTS
The initial management included performing a wide surgical debridement, with the removal of infected and necrotic tissue extending bilaterally from the forehead to the mouth. Split skin grafts were used to cover the extensive tissue defects. Subsequent horizontal eyelid shortening and full-thickness skin was required to correct severe cicatricial ectropions, eyelid displacement and improve lagophthalmos.


CONCLUSIONS
Necrotising fasciitis is an acute fulminant infection of the subcutaneous fat and deep fascia. The initial appearance may look like cellulitis but necrosis quickly follows. Facial disease with extensive periocular involvement represents a significant management challenge.
Poitelea
Cornelia
C
Department of Ophthalmology, Eastbourne District General Hospital, East Sussex, U.K. M.I.Poitelea@sussex.ac.uk
Wearne
Michael J
MJ
D000368:Aged; D003646:Debridement; D005141:Eyelid Diseases / Q000382:microbiology / Q000601:surgery*; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D016867:Immunocompromised Host; D007299:Insect Bites and Stings / Q000150:complications*; D008297:Male; D011552:Pseudomonas Infections / Q000209:etiology / Q000601:surgery*; D016038:Skin Transplantation; D018461:Soft Tissue Infections / Q000382:microbiology / Q000601:surgery*