The acute necrotizing periorbital fasciitis. Clinical case

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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.

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About the authors

Natalia N. Haritonova

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: natal56@mail.ru
ORCID iD: 0000-0002-8550-7171
SPIN-code: 9277-7406
Scopus Author ID: 55047042700
ResearcherId: N-3214-2016

Cand. Sci. (Med.), Assistant Professor of the Department of Ophthalmology

Russian Federation, Saint Petersburg

Dmitriy S. Gorbachev

S.M. Kirov Military Medical Academy

Email: dmitrij-gor@yandex.ru

Cand. Sci. (Med.), Assistant Professor, Assistant of the Department of Ophthalmology

Russian Federation, Saint Petersburg

Maksim S. Safonov

I.I. Dzhanelidze St. Petersburg Scientific Research Institute of Ambulance

Email: Safonovmaksim@mail.ru

Surgeon of the Burn Department

Russian Federation, Saint Petersburg

Aleksey A. Kolbin

S.M. Kirov Military Medical Academy

Email: zd97@mail.ru
SPIN-code: 4718-5171

Head of the Purulent Department of the Ophthalmology Clinic of the Department of Ophthalmology

Russian Federation, Saint Petersburg

Alexey N. Kulikov

S.M. Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
ORCID iD: 0000-0002-5274-6993
SPIN-code: 6440-7706
Scopus Author ID: 57001225300
ResearcherId: M-2094-2016

Dr. Sci. (Med.), Assistant Professor, Head of the Department of Ophthalmology

Russian Federation, Saint Petersburg

Alena A. Kolke

I.I. Dzhanelidze St. Petersburg Scientific Research Institute of Ambulance

Email: a.kolke@mail.ru

Plastic Surgeon of the Burn Department

Russian Federation, Saint Petersburg

Ildar M. Batyrshin

I.I. Dzhanelidze St. Petersburg Scientific Research Institute of Ambulance

Email: Onrush@mail.ru

Head of the Department of Surgical Infections

Russian Federation, Saint Petersburg

Evgeny V. Zinoviev

I.I. Dzhanelidze St. Petersburg Scientific Research Institute of Ambulance

Email: evz@list.ru

Dr. Sci. (Med.), Professor, Chief freelance specialist-kombustiologist of the Ministry of Health

Russian Federation, Saint Petersburg

References

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2. Fig. 1. CT of the patient at the beginning of the disease: a – coronary projection, thickening and increasing density of subcutaneous tissues, temporal fascia and muscle on the right; b – axial projection, infiltration, edema and compaction of tissues of the periorbital region with transition to the temporal fascia. The arrows show the thickened fascia on the right

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3. Fig. 2. Appearance of the patient on the day of hospitalization: a – strain edema and infiltration of the right periorbital, buccal, parotid areas, neck, necrosis of the eyelid skin; b – drains installed after surgery on the day of hospitalization

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4. Fig. 3. A patient in the intensive care ward: a – appearance after opening and drainage of the purulent-necrotic cavities of cheek and neck; b – necrotic wounds of the upper and lower eyelids; c, d – computed tomography, reduction of infiltration and edema of the soft tissues of the periorbital and temporal regions. Blue arrows show drains, yellow arrows show fenestrated fascia with areas of melting

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5. Fig. 4. The appearance of the patient in dynamics on the background of conservative treatment of purulent wounds in accordance with the T.I.M.E. protocol: a – purulent-necrotic wounds of both eyelids after removal of drains immediately at transfer from the intensive care unit; b – cleared granulating wounds of the eyelids 3 weeks after the beginning of threatment before surgery

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6. Fig. 5. Stages of surgical procedure: a – permanent ankylosing blepharorraphy performed, tangential excision of wounds, suturing and drainage of cheek and neck wounds were performed; b – Full-layer flaps were transplanted to the upper and lower eyelids

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7. Fig. 6. Postoperative period. Appearance of the patient: a – at discharge from the hospital (healed eyelid flaps); b – appearance of the patient 1 month postoperatively (postop ankyloblepharone, the onset of pathological scarring); c – appearance of the patient 3 months after surgery (postop ankyloblepharone, scarring epicanthus)

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8. Fig. 7. Stages of reconstructive plastic surgery of the patient: a – appearance of the patient after removal of cicatricial epicanthus 3 months later the first reconstructive surgery; b – the results of lateral canthoplasty and Z-shaped plastic surgery of the lateral third of the upper eyelid 6 months after the beginning of the disease

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9. Fig. 8. The appearance of the patient after all stages of reconstructive treatment 1 year after the beginning of the disease

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Copyright (c) 2022 Haritonova N.N., Gorbachev D.S., Safonov M.S., Kolbin A.A., Kulikov A.N., Kolke A.A., Batyrshin I.M., Zinoviev E.V.

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