Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment-A New Case Report and Systematic Review

Abstract

(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient's survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities.

Keywords: enucleation; fascial flap; necrosis; periorbital necrotizing fasciitis; skin graft.

Figure 1

67-year-old male, with periorbital necrotizing fasciitis: (A) left hemifacialedema; (B) abundant yellowish secretions; and (C) area of necrosis (10/7 cm).

Figure 2

MRI examination: (A–C) subcutaneous emphysema and edema of the left hemiface.

Figure 3

Surgical approach: (A) necrectomy; (B) extensive fasciotomy; (C) enucleation of the left eyeball; and (D) bone exposure (result after extensive debridement).

Figure 4

Postoperative evolution and the causes of flap necrosis.

Figure 5

(A) Parieto-occipital fascial flap necrosis. (B) Surgical approach after parieto-occipital fascial flap necrosis—periosteal removal. (C) Immediate postoperative results.

Figure 6

(A,B) Postoperative results at 6 months. (C,D) Postoperative results at 1 year.

Figure 7

Search process and records included and excluded.