The acute necrotizing periorbital fasciitis. Clinical case

Abstract

BACKGROUND: A rare severe, characterized by high mortality in some localizations (up to 70%) necrotizing periorbital fasciitis has not been described previously in the national literature.

AIM: to show a multidisciplinary approach to the treatment and rehabilitation of patients with periorbital necrotizing fasciitis on the example of the clinical case.

CLINICAL CASE: Patient with the acute necrotizing fasciitis of both eyelids, with the dissemination to the superficial face and neck fascies, the sepsis development is given. Monitoring of vital functions, homeostasis indicators, repeated inoculations, computed tomography, regular examination by an ophthalmologist included the control of visual functions, anterior and posterior segments, closure of the eye fissure. Conservative and surgical treatment applied by a multidisciplinary team is presented, which allowed to save the patient’s life, overpass the purulent-necrotic, and then the rough scar process and to achieve satisfactory anatomical and functional results.

CONCLUSION: Timely multidisciplinary treatment of periorbital necrotizing fasciitis is necessary for the life preservation, prevention of severe complications from the eye. With the threat of developing lagophthalmos, it is necessary to perform permanent blepharoraphy for 3–6 months after the first surgery and further surgical and pharmacological correction of scarring processes.

Keywords

necrotizing fasciitis / periorbital localization / multiple organ failure / multidisciplinary approach / scarring deformation of the eyelids / lagophthalmos / scarring epicanthus / multistage reconstructive surgery

References

[1] Grinev MV, Korolkov AYu, Grinev KM, Beybalaev KZ. Necrotizing fasciitis – a clinical model of the department of public health: medicine of critical state. Grekov’s Bulletin of Surgery. 2013;172(2): 32–38. (In Russ.) DOI: 10.24884/0042-4625-2013-172-2-032-038

[2] Гринёв М.В., Корольков А.Ю., Гринёв К.М., Бейбалаев К.З. Некротизирующий фасциит — клиническая модель раздела здравоохранения: медицины критических состояний // Вестник хирургии имени И.И. Грекова. 2013. Т. 172, № 2. С. 32–38. DOI: 10.24884/0042-4625-2013-172-2-032-038

[3] Aliev SA, Aliev ÉS, Zeĭnalov BM. Fournie´s disease in the light of modern ideas. Pirogov Russian journal of surgery. 2014;(4):34–39. (In Russ.)

[4] Алиев С.А., Алиев Э.С., Зейналов Б.М. Гангрена Фурнье в свете современных представлений // Хирургия. Журнал им. Н.И. Пирогова. 2014. № 4. С. 34–39.

[5] Bellapianta JM, Ljungqist K, Tobin E, Richard U. Necrotizing fasciitis. J Am Acad Orthop Surg. 2009;17(3):174–182. DOI: 10.5435/00124635-200903000-00006

[6] Bellapianta J.M., Ljungqist K., Tobin E., Richard U. Necrotizing fasciitis // J Am Acad Orthop Surg. 2009. Vol. 17, No. 3. P. 174–182. DOI: 10.5435/00124635-200903000-00006

[7] Tambe K, Tripathi A, Burns J, Sampath R.. Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients. Eye. 2012;26:463–467. DOI: 10.1038/eye.2011.241

[8] Tambe K., Tripathi A., Burns J., Sampath R.. Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients // Eye. 2012. Vol. 26. P. 463–467. DOI: 10.1038/eye.2011.241

[9] Balaggan KS, Goolamali SI. Periorbital necrotising fasciitis after minor trauma. Graefes Arch Clin Exp Ophthalmol. 2006;244:268–270. DOI: 10.1007/s00417-005-0078-4

[10] Balaggan K.S., Goolamali S.I. Periorbital necrotising fasciitis after minor trauma // Graefes Arch Clin Exp Ophthalmol. 2006. Vol. 244. P. 268–270. DOI: 10.1007/s00417-005-0078-4

[11] Herdiana TR, Takahashi Y, Valencia RP, et al. Periocular necrotizing fasciitis with toxic shock syndrome. Case Rep Ophthalmol. 2018;9(2):299–303. DOI: 10.1159/000488971

[12] Herdiana T.R., Takahashi Y., Valencia R.P., et al. Periocular necrotizing fasciitis with toxic shock syndrome // Case Rep Ophthalmol. 2018. Vol. 9, No. 2. P. 299–303. DOI: 10.1159/000488971

[13] Kent D, Atkinson PL, Patel B, Davies EWG. Fatal bilateral necrotising fasciitis of the eyelids. Br J Ophthalmol. 1995;79:95–96. DOI: 10.1136/bjo.79.1.95

[14] Kent D., Atkinson P.L., Patel B., Davies E.W.G. Fatal bilateral necrotising fasciitis of the eyelids // Br J Ophthalmol. 1995. Vol. 79. P. 95–96. DOI: 10.1136/bjo.79.1.95

[15] Shield DR, Servat J, Paul S, et al. Periocular necrotizing fasciitis causing blindness. JAMA Ophthalmol. 2013;131(9):1225–1227. DOI: 10.1001/jamaophthalmol.2013.4816

[16] Shield D.R., Servat J., Paul S., et al. Periocular necrotizing fasciitis causing blindness // JAMA Ophthalmol. 2013. Vol. 131, No. 9. P. 1225–1227. DOI: 10.1001/jamaophthalmol.2013.4816

[17] Kronish JW, McLeish WM. Eyelid necrosis and periorbital necrotizing fasciitis. Report of a case and review of the literature. Ophthalmology. 1991;98(1):92–98. DOI: 10.1016/s0161-6420(91)32334-0

[18] Kronish J.W., McLeish W.M. Eyelid necrosis and periorbital necrotizing fasciitis. Report of a case and review of the literature // Ophthalmology. 1991. Vol. 98, No. 1. P. 92–98. DOI: 10.1016/s0161-6420(91)32334-0

[19] Dowsett C, Ayello E. TIME principles of chronic wound bed preparation and treatment. Br J Nurs. 2004;13(15):S16–S23. DOI: 10.12968/bjon.2004.13.Sup3.15546

[20] Dowsett C., Ayello E. TIME principles of chronic wound bed preparation and treatment // Br J Nurs. 2004. Vol. 13, No. 15. P. S16–S23. DOI: 10.12968/bjon.2004.13.Sup3.15546

[21] Kolke AA, Zinoviev EV, Zavatskii VV. Applicability of biomedical products in patients with diabetic foot syndrome. Emergency medical care. 2020;21(4):63–69. (In Russ.) DOI: 10.24884/2072-6716-2020-21-4-63-69

[22] Кольке А.А., Зиновьев Е.В., Завацкий В.В. Целесообразность применения биомедицинских клеточных продуктов у пациентов с синдромом диабетической стопы // Скорая медицинская помощь. 2020. Т. 21, № 4. С. 63–69. DOI: 10.24884/2072-6716-2020-21-4-63-69

RIGHTS & PERMISSIONS

Haritonova N.N., Gorbachev D.S., Safonov M.S., Kolbin A.A., Kulikov A.N., Kolke A.A., Batyrshin I.M., Zinoviev E.V.