A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature

Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valu...

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Autores: Oliver-Gutierrez, David|||0000-0002-0492-8645, Ros-Sanchez, Elena, Segura-Duch, Gloria, Alonso, Tirso, Arcediano, Miguel Ángel|||0000-0001-7234-4919, Herranz Cabarcos, Alejandra|||0000-0002-9407-454X, Matas, Jessica|||0000-0003-4448-5575, Castro Seco, Roberto, Van der Veen, R. L. P., Boixadera Espax, Anna, García Arumí, José|||0000-0001-8827-1160, Oliveres, Joan
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:311315
Acceso en línea:https://ddd.uab.cat/record/311315
https://dx.doi.org/urn:doi:10.3390/diagnostics15091181
Access Level:acceso abierto
Palabra clave:Necrotizing fasciitis
Eye infections
Soft tissue infections
Cellulitis
Orbit
Necrosis
Streptococcus pyogenes
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spelling A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of LiteratureOliver-Gutierrez, David|||0000-0002-0492-8645Ros-Sanchez, ElenaSegura-Duch, GloriaAlonso, TirsoArcediano, Miguel Ángel|||0000-0001-7234-4919Herranz Cabarcos, Alejandra|||0000-0002-9407-454XMatas, Jessica|||0000-0003-4448-5575Castro Seco, RobertoVan der Veen, R. L. P.Boixadera Espax, AnnaGarcía Arumí, José|||0000-0001-8827-1160Oliveres, JoanNecrotizing fasciitisEye infectionsSoft tissue infectionsCellulitisOrbitNecrosisStreptococcus pyogenesBackground: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis' (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient's eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock. 22025-01-0120252025-01-01Article de revisióhttp://purl.org/coar/resource_type/c_dcae04bcVoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/311315https://dx.doi.org/urn:doi:10.3390/diagnostics15091181reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3113152026-06-06T12:50:31Z
dc.title.none.fl_str_mv A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
title A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
spellingShingle A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
Oliver-Gutierrez, David|||0000-0002-0492-8645
Necrotizing fasciitis
Eye infections
Soft tissue infections
Cellulitis
Orbit
Necrosis
Streptococcus pyogenes
title_short A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
title_full A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
title_fullStr A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
title_full_unstemmed A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
title_sort A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
dc.creator.none.fl_str_mv Oliver-Gutierrez, David|||0000-0002-0492-8645
Ros-Sanchez, Elena
Segura-Duch, Gloria
Alonso, Tirso
Arcediano, Miguel Ángel|||0000-0001-7234-4919
Herranz Cabarcos, Alejandra|||0000-0002-9407-454X
Matas, Jessica|||0000-0003-4448-5575
Castro Seco, Roberto
Van der Veen, R. L. P.
Boixadera Espax, Anna
García Arumí, José|||0000-0001-8827-1160
Oliveres, Joan
author Oliver-Gutierrez, David|||0000-0002-0492-8645
author_facet Oliver-Gutierrez, David|||0000-0002-0492-8645
Ros-Sanchez, Elena
Segura-Duch, Gloria
Alonso, Tirso
Arcediano, Miguel Ángel|||0000-0001-7234-4919
Herranz Cabarcos, Alejandra|||0000-0002-9407-454X
Matas, Jessica|||0000-0003-4448-5575
Castro Seco, Roberto
Van der Veen, R. L. P.
Boixadera Espax, Anna
García Arumí, José|||0000-0001-8827-1160
Oliveres, Joan
author_role author
author2 Ros-Sanchez, Elena
Segura-Duch, Gloria
Alonso, Tirso
Arcediano, Miguel Ángel|||0000-0001-7234-4919
Herranz Cabarcos, Alejandra|||0000-0002-9407-454X
Matas, Jessica|||0000-0003-4448-5575
Castro Seco, Roberto
Van der Veen, R. L. P.
Boixadera Espax, Anna
García Arumí, José|||0000-0001-8827-1160
Oliveres, Joan
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Necrotizing fasciitis
Eye infections
Soft tissue infections
Cellulitis
Orbit
Necrosis
Streptococcus pyogenes
topic Necrotizing fasciitis
Eye infections
Soft tissue infections
Cellulitis
Orbit
Necrosis
Streptococcus pyogenes
description Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis' (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient's eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article de revisió
http://purl.org/coar/resource_type/c_dcae04bc
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/311315
https://dx.doi.org/urn:doi:10.3390/diagnostics15091181
url https://ddd.uab.cat/record/311315
https://dx.doi.org/urn:doi:10.3390/diagnostics15091181
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
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https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
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collection Dipòsit Digital de Documents de la UAB
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