Modified wound closure technique in periorbital necrotizing fasciitis

Predicting severity of periorbital necrotizing fasciitis

PURPOSE

To determine whether severity of periorbital necrotizing fasciitis can be predicted based on premorbid patient characteristics.

METHODS

Records of 10 consecutive patients with periorbital necrotizing fasciitis presenting at a single center, treated by one attending ophthalmic plastic surgeon, were retrospectively reviewed. Demographic information and medical history were used to determine a Charlson Comorbidity Index (CCI) score for each patient. Other variables included presenting visual acuity, number of surgical debridements performed, infectious organism (if known), and visual acuity at last follow-up. Data were compared with Mann-Whitney U test to determine correlation between variables, using p-values as outcome measures.

RESULTS

Increased age at presentation correlated with worse presenting and final visual acuity, requiring more surgical debridements to control disease (each p < .0001). Worse initial visual acuity correlated with need for increased number of debridements (p = .002), but increased number of debridements did not correlate with final visual acuity (p = .101). CCI did not correlate with initial vision (p = .30), final vision (p = .72), or number of surgical debridements necessary (p = .99). Presenting visual acuity did not correlate with final visual acuity (p = .268).

CONCLUSION

Older patients have more severe cases of periorbital necrotizing fasciitis, as defined by increased number of surgeries required to control disease and worse visual outcomes. CCI did not correlate with severity of disease.

Necrotizing fasciitis complicated with multiple organ dysfunction syndrome after breast augmentation with fat from the waist and lower extremities: a case report

Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection with a mortality rate as high as 30% to 50%. However, the incidence rate of NF after liposuction is extremely low. In the current case report, we describe a woman with NF who developed multiple organ dysfunction syndrome (MODS) after fat acquisition. The aim of this paper is to summarize the management of these patients. After debridement and drainage, correction of multiple organ failure, and plastic surgery, the patient’s organ and lower limb functions improved to a normal level. Early diagnosis, early operative treatment, and correction of systemic abnormalities are the keys to successful recovery of patients with NF complicated with MODS after liposuction.