title: 'Stalled' periocular necrotising fasciitis: early effective treatment or host genetic determinants?
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.
  
  
  CONCLUSIONS
  The role of host genetic determinants, polarised cytokine responses, and early, effective medical treatment in patients with atypical 'disease phenotypes' in NF are discussed.
authors: Orbital Unit, Moorfields Eye Hospital, London, UK.
authors: A
authors: A
authors: Mutamba
authors: D H
authors: DH
authors: Verity
authors: G E
authors: GE
authors: Rose
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019882:Blepharoplasty; D003646:Debridement; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D005141:Eyelid Diseases / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D005260:Female; D033141:Genetic Determinism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D013524:Surgical Flaps; D018417:Th1 Cells / Q000276:immunology; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents