Debride or irrigate – a single center case study on managing periorbital necrotizing fasciitis
Author: Louisa Michaels
Base Hospital / Institution: Asklepios clinic Barmbek, Hamburg. Department for ophthalmology
Rapid fire oral presentation
Abstract ID: 25-601
Purpose
Periorbital necrotizing fasciitis (PNF) is a life-threatening condition. Its treatment poses unique challenges due to the risk of disfigurement and vision loss. Surgical management varies depending on the amount of tissue involvement. Extensive debridement has been traditionally advocated as the initial surgical therapy, but recently, the focus has shifted towards a more tissue –sparing regimen.In this case series, we present six patients treated for PNF between May 2023 and July 2024 in our department.
Methods
5 male, 1 female; mean age 61.3years (33 to 88). Previous history: trauma (3 cases), prior surgical intervention (2 cases) and prior ear infection (1 case). Risk factors: substance abuse (2 patients), cardiovascular comorbidities (3 cases). One patient was otherwise healthy. All patients presented with rapid onset of periorbital swelling, altered skin and severe pain.
Results
All patients underwent surgical intervention within 12 hours of admission. Broad-spectrum antibiotics were administered perioperatively. Microbiology: Streptococcus pyogenes in all cases. Surgical management: surgical cleaning, (povidone-iodine and polyhexanide), “easy-flow” drain placement, frequent irrigation with octenisept. One patient died following septic shock. Two achieved full restoration of eyelid anatomy and function. Two showed mild ptosis or minor eyelid closure deficit, with no need for reconstructive procedures.One patient was lost to follow up.
Conclusion
PNF requires rapid recognition and aggressive early treatment. Our experience supports the assumption that debridement can be limited and tissue irrigation is the treatment of choice in order to preserve as much tissue as possible. While hyypochlorous acid and/or clindamycin has been advocated, our patients did well with octenisept irrigation.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Christina | Schneemann | Asklepios clinic Barmbek, Hamburg. Department for ophthalmology |
| Ulrich | Schaudig |
