title: Negative pressure wound therapy in preseptal orbital cellulitis complicated with necrotizing fasciitis and preseptal abscess.
abstract: OBJECTIVE
  Preseptal cellulitis (PC) may be locally complicated with abscess formation and necrotizing fasciitis. If not treated promptly and adequately, it may result in further complications. The authors report a series of patients where negative pressure wound therapy (NPWT) proved a safe and valuable adjunct therapy in avoiding complications of PC and in accelerating wound healing.
  
  
  METHODS
  A 4 patient case series. Four male patients (11 months to 58 years old) with unilateral complicated PC.
  
  
  METHODS
  Patients were admitted with PC and treated initially with specific intravenous antibiotic therapy. These patients did not respond adequately; therefore, surgical drainage and/or debridement were performed. After surgery, persistent edema and purulent discharge was observed prompting the need for adjunct NPWT every 48 to 72 hours. NPWT is the use of vacuum through a wound filler material covered with an airtight drape connected to a pump. Complete ophthalmologic examination was performed after each 48-hour cycle. Length of hospital stay, days from surgery to discharge, days from start of NPWT to discharge, clinical improvement, and safety.
  
  
  RESULTS
  Four patients were diagnosed with PC between 2 and 5 days of evolution. Two diabetic adults developed the condition secondary to trauma, the adolescent as a result of a cosmetic piercing, and the infant associated to sinusitis. NPWT reached -125 mm·Hg, except for the infant who received -75 mm·Hg. The average number of days necessary for improvement with NPWT was 6.7 days. Only 2 patients required surgical reconstruction. Time from debridement to discharge was in average 13.5 days. No ocular complications were observed, and follow up was satisfactory with normal eyelid function and aesthetics and preserved visual acuity.
  
  
  CONCLUSIONS
  NPWT proved to be safe and effective for treating locally complicated PC as an adjuvant therapy to antibiotic and surgical treatment that decreased the length of hospital stay, and the time for recovery in patients that were slow responders. No ocular complications were observed in any of these patients' follow up ranging from 1 to 4 years.
authors.affiliation: * Interdisciplinary wound and ostomy care center; †Division of ophthalmology; ‡Division of dermatology; §Division of plastic surgery; and ‖Oculoplastics section, Division of ophthalmology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: José
authors.initials: J
authors.lastname: Contreras-Ruiz
authors.forename: Angeles
authors.initials: A
authors.lastname: Ramos-Cadena
authors.forename: Patricia
authors.initials: P
authors.lastname: Solis-Arias
authors.forename: Adriana
authors.initials: A
authors.lastname: Lozano-Platonoff
authors.forename: Lirio A
authors.initials: LA
authors.lastname: Lopez-García
authors.forename: Martha E
authors.initials: ME
authors.lastname: Contreras-Barrera
authors.forename: Claudia
authors.initials: C
authors.lastname: Saenz-Corral
authors.forename: Isabel
authors.initials: I
authors.lastname: de-la-Cruz-Garcia
authors.forename: Alexander
authors.initials: A
authors.lastname: Cárdenas-Mejía
authors.forename: Rubén
authors.initials: R
authors.lastname: Lopez-Oliver
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003646:Debridement; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D054517:Orbital Cellulitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002939:Ciprofloxacin; D002443:Ceftriaxone