Multidisciplinary Approach in Rare, Fulminant-Progressing, and Life-Threatening Facial Necrotizing Fasciitis

Abstract

(1) Background: Necrotizing fasciitis is known as a severe condition with a high risk of mortality, placing it among the most feared infections. In most cases, it has a polymicrobial etiology (type 1), requiring complex treatment that is continuously adapted to the evolving microbiological status. The facial localization of the disease is rare, fulminant progressing, and is often life-threatening. (2) Methods: We present the case of a patient with multiple comorbidities who, following trauma to the nasal dorsum, developed a wound with a rapid and severe progression to extensive bilateral periorbital necrosis. This was accompanied by a dramatic deterioration in their general condition, a polymicrobial biological status, and fluctuating progression despite instituted treatment (both medical and surgical). (3) Results: The patient required multiple surgical interventions by multidisciplinary teams (plastic surgery; ear, nose, and throat specialist (ENT); maxillofacial surgery; and ophthalmology), experiencing periods of a severe, life-threatening general condition, necessitating prolonged orotracheal intubation. Wounds with fluctuating progression, extensive skin necrosis, and significant post-excisional soft tissue defects required skin graft coverage. The result meant a saved life and functional and aesthetic sequelae at the level of the face. (4) Conclusions: Necrotizing fasciitis of the face is a rare and severe disease that must be recognized early and treated appropriately by a multidisciplinary team to save the patient's life and minimize the resulting functional and aesthetic sequelae.

Keywords: debridation; facial trauma; fulminant progression; necrotizing fasciitis; reconstructions.

Figure 7

(a,b) Granulating wounds; (c,d) split-thickness skin graft, right lateral and left lateral views, respectively.

Figure 1

The clinical appearance of the patient at the time of admission to the hospital (areas of necrosis in the eyelids of both eyes).

Figure 2

(a–c) Hematomas were also observed in the soft tissues of the face, including the perizygomatic areas bilaterally, anterior to the maxillary sinuses bilaterally, peri- and latero-orbital regions bilaterally, and perinasal areas, with a maximum thickness of 35 mm with significant swelling.

Figure 3

Postoperative view. (a) Temporal skin incisions. (b) Aspect after first necrectomy. (a,b) Extensive areas of necrosis around both eyes.

Figure 4

The progression of biological constants in the first 10 days after hospital admission. WBCs—white blood cells; Hb—hemoglobin; CRP—C-reactive protein.

Figure 5

The extension of the areas of necrosis after the first necrectomy with the worsening of the general condition. (a) Day 4 after the first excision, (b–d) unfavorable progression with the extension of necrotic areas.

Figure 6

Post-excisional appearance: (a) first day after last excision, (b–d) 5th day post-excision—favorable progression.

Figure 8

Appearance 3 months after discharge from hospital.