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Wladis EJ. Periorbital Necrotizing Fasciitis. Surv Ophthalmol 2022; 67:1547-1552. [DOI: 10.1016/j.survophthal.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Shivalingappa S, Manjunath KN, Waiker V, Kumaraswamy M, Odeyar U. Necrotising Fasciitis: Appearances Can Be Deceptive. World J Plast Surg 2021; 10:43-52. [PMID: 33833953 PMCID: PMC8016375 DOI: 10.29252/wjps.10.1.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis is a potentially fatal infection of β hemolytic Group-A Streptococcus, often occurring in patients with other comorbidities, but can occur in healthy individuals as well. It commonly affects the extremities, perineum, and abdominal wall. The aim of this study was to highlight various presentations of necrotizing fasciitis in unusual anatomical sites with delayed diagnosis and treatment. METHODS In a retrospective analysis, seven cases of unusual presentations of necrotizing fasciitis were enrolled during a period of five years treated in a tertiary centre. RESULTS The patients were between 23 and 80 years. Four were males and three were females. Four out of seven were diabetic. All patients had septicemia (hypovolemic shock, with leucocytosis, thrombocytopenia and deranged coagulation parameters) on admission in the intensive care unit. All seven patients had minimal cutaneous manifestation and the remote primary pathology was diagnosed in two patients. Six patients out of seven survived and the morbid state continued in one patient in view of malignancy of rectum in one patient. The overall outcome was satisfactory in five out of seven cases. CONCLUSION Pain disproportionate to the local inflammation with florid constitutional symptoms should raise suspicion of necrotizing fasciitis. Early diagnosis, of stabilization of hemodynamics, emergency fasciotomy, staged debridement and the initiation of broad spectrum antibiotics reduced the morbidity and mortality. The disease may manifest with uncommon presentations and sometimes lead to the diagnosis of primary aetiology.
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Affiliation(s)
| | - K N Manjunath
- Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, India
| | - Veena Waiker
- Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, India
| | - M Kumaraswamy
- Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, India
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Marchesi A, Marcelli S, Parodi PC, Perrotta RE, Riccio M, Vaienti L. Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature. Aesthetic Plast Surg 2017; 41:352-358. [PMID: 28062962 DOI: 10.1007/s00266-016-0754-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/25/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. MATERIALS AND METHODS We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. RESULTS Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. CONCLUSIONS In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
| | - Stefano Marcelli
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
| | - Pier C Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Rosario E Perrotta
- Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Luca Vaienti
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
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Abstract
Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.
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Affiliation(s)
- Shantha Amrith
- Department of Ophthalmology, National University Health System, Singapore City, SingaporeDepartment of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, IndiaSingapore Eye Research Institute, Singapore National Eye Center, Singapore City, Singapore
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Ortiz-Pérez S, Latasiewicz M, Castellá C, Fernández E. ¿Son las celulitis palpebrales preseptales siempre banales? Enferm Infecc Microbiol Clin 2012; 30:422-3. [DOI: 10.1016/j.eimc.2012.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 11/28/2022]
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Laouar K, Ruban JM, Baggio E, Dupeyron G. [Cosmetic blepharoplasty complicated by necrotizing periorbital fasciitis: a case report]. J Fr Ophtalmol 2012; 35:437.e1-8. [PMID: 22633216 DOI: 10.1016/j.jfo.2011.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/12/2011] [Accepted: 07/19/2011] [Indexed: 10/28/2022]
Abstract
Necrotizing periorbital or palpebro-orbital fasciitis represents a unique anatomical site for necrotizing fasciitis, which is an extremely rare and very severe, potentially devastating bacterial infection, rapidly leading to facial necrosis with loss of vision and even death of the patient from toxic shock. In this paper, we report a case of necrotizing periorbital fasciitis as a complication of cosmetic lower eyelid blepharoplasty. Necrotizing fasciitis most often affects the upper and lower limbs, the trunk and the perineal area. It is rarely observed in the facial region due to the rich blood supply in this area. The most commonly implicated pathogen is group A, β-hemolytic "pyogenic"Streptococcus, either alone or in combination with other bacteria, such as staphylococcus or pseudomonas. Mortality varies according to the series and anatomical site. The mortality rate for necrotizing fasciitis is approximately 28 %. It is slightly lower in the periorbital area (15 %). Risk factors for death include alcoholism, diabetes mellitus, immunocompromise, hematologic or pulmonary diseases, and the identity of the causative agent (group A Streptococcus), although approximately 50 % of patients have no predisposing conditions. Management of periorbital necrotizing fasciitis is based on early detection of initial symptoms and on aggressive multidisciplinary treatment including surgical debridement of necrotic areas and antibiotic coverage. The timeliness of treatment and the multidisciplinary approach are considered to be the two essential factors in influencing the mortality and morbidity of this condition.
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Affiliation(s)
- K Laouar
- Service d'ophtalmologie, centre hospitalo-universitaire Carémeau, place du Pr.-Debré, 30029 Nîmes, France.
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Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients. Eye (Lond) 2011; 26:463-7. [PMID: 22157919 DOI: 10.1038/eye.2011.241] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Necrotising fasciitis is an uncommon but life-threatening soft tissue infection characterised by rapidly spreading inflammation and necrosis of skin, subcutaneous fat and fascia. Left untreated, the mortality can be more than 70%. Early surgical intervention can reduce morbidity and mortality. PATIENTS AND METHODS This is a series of 11 patients who presented to our oculoplastic and orbit unit with periocular necrotising fasciitis over a period of five years. We present the modes of presentation, predisposing factors, diagnosis, and the multidisciplinary team management of these patients. RESULTS Of the 11 patients, 1 patient died and 2 patients required intensive care management. Of the 10 surviving patients, 8 patients needed further surgical interventions for correction of complications, like eyelid malposition, ptosis and protective or corrective surgery in the form of ectropion correction, skin grafting and other rehabilitative procedures. CONCLUSION To the best of our knowledge, this is the largest series of periocular necrotising fasciitis in the literature. Necrotising fasciitis is a potentially fatal condition, resulting in a high rate of mortality and morbidity. Early surgical intervention reduces the mortality. A high index of suspicion is needed to make a prompt diagnosis. These patients need expeditious intervention and may require a long follow-up and subsequent surgery for complications related to scarring and other sequelae.
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Lazzeri D, Lazzeri S, Figus M, Agostini T, Nardi M, Pantaloni M. Hyperbaric oxygen therapy as further adjunctive therapy in the treatment of periorbital necrotizing fasciitis caused by group A Streptococcus. Ophthalmic Plast Reconstr Surg 2011; 26:504-5; author reply 505. [PMID: 20811307 DOI: 10.1097/iop.0b013e3181e26821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lazzeri D, Agostini T. Eyelid and periorbital necrotizing fasciitis as an early devastating complication of blepharoplasty. Plast Reconstr Surg 2010; 126:1112-1113. [PMID: 20811246 DOI: 10.1097/prs.0b013e3181e606a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Davide Lazzeri
- Plastic and Reconstructive Surgery Unit (Lazzeri) Burn Center Unit; Hospital of Pisa; Pisa, Italy (Agostini)
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Reply. Plast Reconstr Surg 2010. [DOI: 10.1097/prs.0b013e3181e6cf92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schurr C, Burghartz M, Miethke T, Kesting M, Hoang N, Staudenmaier R. Management of facial necrotizing fasciitis. Eur Arch Otorhinolaryngol 2008; 266:325-31. [PMID: 19043730 DOI: 10.1007/s00405-008-0870-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
Abstract
Necrotizing fasciitis is a progressive, life-threatening, bacterial infection of the skin, the subcutaneous tissue and the underlying fascia, in most cases caused by ss-hemolytic group A streptococcus. Only early diagnosis and aggressive therapy including broad spectrum antibiotics and surgical intervention can avoid systemic toxicity with a high mortality rate. This uncommon disease generally occurs in the lower extremities and trunk, and only rarely affects the head and neck region. When located in the face necrotizing fasciitis is associated with severe cosmetic and functional restrictions due to the invasive infection and often to the necessary surgical treatment. Generally surgical intervention cannot be performed in the face as aggressively as in the extremities and trunk, since a lot of vital structures are found in a relatively small area. In the following article, we present the successful diagnostic and therapeutic management of an isolated facial necrotizing fasciitis as a consequence of a nasal bone fracture with a minor dermal cut.
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Affiliation(s)
- Christian Schurr
- Klinik für Hals-Nasen-Ohren-Heilkunde, Technische Universität München, Munich, Germany.
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Chiu ES, Capell BC, Capel B, Press R, Aston SJ, Jelks EB, Jelks GW. Successful Management of Orbital Cellulitis and Temporary Visual Loss after Blepharoplasty. Plast Reconstr Surg 2006; 118:67e-72e. [PMID: 16932160 DOI: 10.1097/01.prs.0000233031.17109.c6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ernest S Chiu
- Division of Plastic and Reconstructive Surgery, Tulane University Health Sciences Center, New Orleans, USA.
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Gindre S, Dellamonica J, Couadau E, Carles M, Vandenbos F, Delgiudice P, Grimaud D, Ichai C. Fasciite nécrosante de la face après exérèse d'un épithélioma spinocellulaire. ANN CHIR PLAST ESTH 2005; 50:233-6. [PMID: 15963844 DOI: 10.1016/j.anplas.2004.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Accepted: 07/07/2004] [Indexed: 11/19/2022]
Abstract
Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due to Streptococcus pyogenes. Head and neck region are some rare localization of this infection especially after surgery. We report herein a case of a face necrotizing fasciitis following minor face surgery. A 86 year-old Caucasian male without any antecedents, nor treatment, has been operated for a fronthead spinocellular epithelioma under local anesthesia. Twelve hours later, a severe pain localized to the face occurred, with sleeplessness, followed up with a face orbitary oedema and fever. Twenty-four hours later, an intravenous antibiotherapy was therefore started and surgical treatment was performed as soon as the diagnosis of necrotizing fasciitis was considered. An important inflammatory oedema was noticed, associated to a large necrotic softening of the face, the eyelid and the neck sub-cutaneous tissues. Then, the patient has been transferred in intensive care unit because multi-organ failure clinical and biological signs occurred. Pre-operatory bacteriological samples culture identified Streptococcus pyogenes. Repeated surgical explorations and debridement (excision, cleaning, draining and bandages recovery) were performed daily as needed until all the necrotic tissue was all eradicated. The antibiotherapy was prescribed to totalised 15 days. Our report underlines the importance of an early recognition of the diagnosis of soft tissue infection, because early surgical treatment has a better prognosis and antibiotic treatment alone is inefficient for the recovery. Alert is delivered by the local signs quickly followed up by skin changes. Anti-inflammatory therapy must be avoid in case of any soft tissue infection sign: they may increase the lesions, hide alarm signs and delay surgical treatment.
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Affiliation(s)
- S Gindre
- Département d'anesthésie et réanimation, hôpital Saint-Roch, 5, rue Pierre-Devoluy, BP 1319, 06006 Nice cedex 01, France.
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Abstract
Because dermatologic procedures disrupt skin integrity, they alter the body's protective barrier and predispose individuals to cutaneous infection. Postoperative wound infections--even with common pathogens such as S. aureus--seldom complicate dermatologic procedures; however, unusual infections have been reported to complicate excisions, biopsies, skin grafts, chemical peels, dermabrasion, laser resurfacing, liposuction, blepharoplasty, and injections (eg, with anesthetic solutions or botulinum toxin). Numerous environmental and patient risk factors increase the rate of postoperative wound infections, but otherwise healthy individuals undergoing relatively simple procedures are sometimes affected. Obtaining a thorough patient, history (including history of prior HSV infection or any immunocompromising factors) is crucial. Patients should be warned of potential complications, particularly when they are undergoing cosmetic procedures. It is important to maintain a high index of suspicion for possible wound infection in all patients that extends several months postoperatively. Manifestations of unusual postoperative infections are highly variable, and they might be secondary to bacterial, fungal, viral, or parasitic pathogens. Bacterial lesions are often polymicrobial, and bacterial superinfection can exacerbate other wound complications such as HSV reactivation. Most wound infections remain localized, but occasionally systemic disease occurs. For example, cutaneous diphtheria or rapidly growing mycobacteria rarely disseminate, whereas TSS results in systemic disease caused by toxin release. Some unusual postsurgical infections are self-limited, but they can still be potentially life threatening or disfiguring. Antimicrobial prophylaxis might reduce the risk of wound infection in some cases. Clinicians can better care for patients by becoming familiar with the causes and clinical manifestations of unusual dermatologic postoperative wound infections (Table 1). Following the recognition of an infectious process, appropriate diagnostic procedures allow for pathogen identification and the prompt institution of indicated therapy.
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MESH Headings
- Animals
- Aspergillus
- Candida
- Corynebacterium
- Enterobacteriaceae
- Fasciitis, Necrotizing/diagnosis
- Fasciitis, Necrotizing/etiology
- Fasciitis, Necrotizing/microbiology
- Fasciitis, Necrotizing/therapy
- Herpesvirus 1, Human
- Humans
- Leishmania
- Mycobacterium
- Shock, Septic/diagnosis
- Shock, Septic/etiology
- Shock, Septic/microbiology
- Shock, Septic/therapy
- Skin Diseases, Infectious/diagnosis
- Skin Diseases, Infectious/etiology
- Skin Diseases, Infectious/microbiology
- Skin Diseases, Infectious/parasitology
- Skin Diseases, Infectious/therapy
- Surgical Wound Infection/complications
- Surgical Wound Infection/microbiology
- Surgical Wound Infection/parasitology
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Affiliation(s)
- Mary E Garman
- Baylor College of Medicine, Department of Dermatology, 1 Baylor Plaza, Houston, TX 77030, USA
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Goldberg RA, Li TG. Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty. Am J Ophthalmol 2002; 134:908-10. [PMID: 12470763 DOI: 10.1016/s0002-9394(02)01848-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a case of group A beta-hemolytic streptococcal infection with signs of early necrotizing fasciitis after cosmetic blepharoplasty in a healthy patient. DESIGN Interventional case report. METHODS A healthy 59-year-old woman underwent outpatient bilateral upper and lower blepharoplasty with midface lifting. Thirty hours postoperatively she developed marked pain and edema of the left eyelids and face, and a violaceous eyelid bulla, which heralded early necrotizing fasciitis. Culture of the serosanguinous exudates from the left eyelid revealed group A beta-hemolytic Streptococcus organisms. RESULTS The patient was treated with intravenous antibiotics, intravenous corticosteroids, hyperbaric oxygen therapy, and wound debridement. The infection resolved with mild cicatrization of the left upper eyelid. CONCLUSIONS Group A beta-hemolytic Streptococcus is an increasingly recognized cause of infection that occurs after trauma or surgery, even in highly vascularized areas such as the eyelids and face. It is a potentially devastating infection, particularly in vascularly compromised patients, and requires immediate and aggressive treatment.
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Affiliation(s)
- Robert A Goldberg
- Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095-7000, USA
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Luksich JA, Holds JB, Hartstein ME. Conservative management of necrotizing fasciitis of the eyelids. Ophthalmology 2002; 109:2118-22. [PMID: 12414425 DOI: 10.1016/s0161-6420(02)01257-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the management of patients with necrotizing fasciitis of the eyelids. DESIGN Retrospective, noncomparative interventional case series. PARTICIPANTS Seven patients with necrotizing fasciitis limited to the eyelids. METHODS Retrospective review of the charts and photographs of seven patients with necrotizing fasciitis limited to the eyelids. MAIN OUTCOME MEASURES Eyelid function and appearance, mortality, and morbidity. RESULTS Seven of seven patients had good eyelid function and adequate appearance without reconstruction after healing. No deaths occurred. CONCLUSIONS Eyelid necrosis due to necrotizing fasciitis can be a devastating condition. The morbidity and mortality of selected cases are reduced with prompt and appropriate antimicrobial therapy and nonaggressive debridement of necrotic tissue after autodemarcation of the necrotic zone.
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Affiliation(s)
- Jason A Luksich
- Saint Louis University Eye Institute, Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA
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Khan A, Ahmad N. Necrotising fasciitis managed without any surgical intervention. Eye (Lond) 2001; 15:811-2. [PMID: 11827019 DOI: 10.1038/eye.2001.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Beeson WH, Slama TG, Beeler RT, Rachel JD, Picerno NA. Group A streptococcal fasciitis after submental tumescent liposuction. ARCHIVES OF FACIAL PLASTIC SURGERY 2001; 3:277-9. [PMID: 11710866 DOI: 10.1001/archfaci.3.4.277] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Tumescent liposuction is a procedure with a good safety record. Local infection is rare but can result in devastating consequences. We report a rare case of group A streptococcal fasciitis complicating tumescent liposuction and highlight the importance of early diagnosis and treatment of this condition. A 62-year-old woman presented 8 days after submental liposuction and a platysmal plication procedure with signs and symptoms of cervical fasciitis. Microbiological analysis confirmed a group A streptococcal infection. By using early aggressive medical and surgical treatments, the disease was arrested before the onset of any necrotizing process. A high index of suspicion is required to make an early diagnosis of this potentially disfiguring and life-threatening infection.
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Affiliation(s)
- W H Beeson
- Beeson Aesthetic Surgery Institute, 13590 N Meridian St, Carmel, IN 46032, USA.
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Rutty GN, Busuttil A. Necrotizing fasciitis: reports of three fatal cases simulating and resulting from assaults. Am J Forensic Med Pathol 2000; 21:151-4. [PMID: 10871131 DOI: 10.1097/00000433-200006000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Necrotizing fasciitis is a progressive, potentially fatal, rapid, necrotizing infection of the subcutaneous tissues and fascia often caused by a mixture of organisms or by infection with group A Streptococcus pyogenes with or without Staphylococcus aureus. Three cases are presented that have been encountered in forensic pathologic practice. Two cases presented after assaults, and the third simulated an assault and burglary. The history, scene, and pathologic findings are presented with a brief review of the literature.
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Affiliation(s)
- G N Rutty
- Department of Forensic Pathology, Medico-Legal Centre, Sheffield, England
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