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Hyperbaric Oxygen as and Adjust to Management of Periocular Necrotizing Fasciitis: A Report of 2 Cases

Alice Song, Julia Song, Michael B Strauss, Michael Song and Trisa Palmares

Introduction: Necrotizing fasciitis is a rare but potentially fatal soft tissue infection. It involves rapidly progressive necrosis of fascia and subcutaneous fat often with necrosis of the overlying skin. Patients may have systemic toxicity, characterized by altered mental status, malaise, leukocytosis, fever, chills, and pain. It most commonly involves the trunk, extremities and perineum. It is often associated with minor trauma, surgery, diabetes mellitus, or intravenous drug abuse. Mortality rate range is 20-40%. Early diagnosis and aggressive treatment are essential for preventing tissue loss and increasing survival.

When necrotizing fasciitis involves the orbit it can threaten vision, lead to cavernous sinus thrombosis and death. Reports indicate that outcomes are usually poor with unsightly scarring, visual impairment or the more serious problems mentioned above.

We report our experience with two patients treated using Hyperbaric Oxygen (HBO) treatments as an adjunct in their management. Both had excellent clinical outcomes with preservation of vision and almost imperceptible cosmetic effects.

Case presentation: Two patients with Group A Streptococcus periocular necrotizing fasciitis were referred to the first author for emergency medical management. Both patients were healthy females with no history of trauma who presented with rapid-onset periocular pain and edema. Antibiotics were started immediately followed by prompt surgical exploration and debridement and post-operative initiation hyperbaric oxygen treatments. Both patients had excellent outcomes results without loss of vision or complex oculoplastic intervention.

Conclusion: Historically, periocular necrotizing fasciitis has had high complications rates. With prompt, aggressive treatment and adjunctive HBO therapy, our 2 patients achieved complete recovery with satisfactory cosmesis and only minimial cicatricial changes. We strongly recommend HBO be used as an adjunct in the management of periocular necrotizing fasciitis.