Purpose

Periorbital necrotizing fasciitis (PNF) is a life-threatening condition and requires immediate antibiotic treatment and surgical intervention. In recent years, the use of surgical drains combined with frequent irrigation has emerged as a tissue-preserving alternative to radical debridement, reducing postoperative facial and eyelid deformities We aim to provide a practical guide for the preparation and placement of drains in periorbital necrotizing fasciitis.

---

Methods

Between May 2023 and July 2024 six patients with PNF were treated in our department. All patients were hospitalized and underwent surgery within 12 hours after admission.

---

Results

In all patients, the surgical approach consisted of surgical cleaning, careful removal of necrotic tissue, placement of silicon “easy-flow” drains and repeated irrigation with octenisept solution. “Easy-flow” drains function passively without suction or vacuum assistance. Prior to insertion, drains were shortened as desired and multiple small semicircular side fenestrations were created. This facilitated intra- and postoperative delivery of octenisept into deep tissue without the need for extensive debridement. Drains were positioned in various orientations to achieve maximal coverage of all suspicious periorbital tissue. Both ends of the drains were left approximately 10mm over skin level on both sides and secured with interrupted sutures. Following clinical improvement, drains were removed bedside.

---

Conclusion

Surgical treatment of PNF remains challenging because of the high risk of extensive tissue loss, disfigurement and loss of vision.
The described surgical approach of strategically prepared and positioned drains represents a fast, tissue-preserving technique, that may reduce the need for secondary reconstructive surgeries.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Christina	Schneemann	Hamburg, Germany
Ulrich	Schaudig	Hamburg, Germany

↑ Back to top