6bf9a1cf0b23b499c46665cf60b7acf7 diagnostics-15-01181.pdf 0b0ff32dc49b94c331d7a4b9ac6e4d88bf6ad1e6 diagnostics-15-01181.pdf 2f1a65bd09931b05b3d4b8137bdbef5925699149cdece795aa442903dbf4dfa4 diagnostics-15-01181.pdf Title: A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature Subject: 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. Keywords: necrotizing fasciitis; eye infections; soft tissue infections; cellulitis; orbit; necrosis; Streptococcus pyogenes Author: David Oliver-Gutierrez, Elena Ros-Sanchez, Gloria Segura-Duch, Tirso Alonso, Miguel Ángel Arcediano, Alejandra Herranz-Cabarcos, Jessica Matas, Roberto Castro Seco, R. L. P. van der Veen, Anna Boixadera, José García-Arumí and Joan Oliveres Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed May 7 14:15:24 2025 CEST ModDate: Wed May 7 14:21:10 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 17 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 907085 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- EYGXKU+VnURWPalladioL Type 1 Custom yes yes yes 10 0 XEUTBA+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 POSZUK+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 ZAECKZ+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 FAECIJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 56 0 JFEFKO+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 73 0 JFEFJN+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 79 0 JFEFIN+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 85 0 JFEFKP+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 91 0 JFEFLA+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 94 0 JFEFLB+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 97 0 JFEGCP+PalatinoLinotype-Roman TrueType MacRoman yes yes no 100 0 FXXUVH+CMSY10 Type 1 Builtin yes yes yes 124 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-05-08 02:07:39 CEST RepresentationInformation: diagnostics-15-01181.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-05-07 18:27:27 CEST Size: 907085 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 533 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Item: Title: Results Destination: section.3 Children: Item: Title: Studies Selection Destination: subsection.3.1 Item: Title: Patient and Necrotizing Fasciitis Features (Table 2) Destination: subsection.3.2 Item: Title: Treatment (Table 3) Destination: subsection.3.3 Item: Title: Outcome (Table 3) Destination: subsection.3.4 Item: Title: Comparative Analysis Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Children: Item: Title: Incidence Destination: subsection.4.1 Item: Title: Pathophysiology Destination: subsection.4.2 Item: Title: Diagnosis Destination: subsection.4.3 Item: Title: Risk Factors Destination: subsection.4.4 Item: Title: Etiology Destination: subsection.4.5 Item: Title: Treatment Destination: subsection.4.6 Item: Title: Outcome Destination: subsection.4.7 Item: Title: Other Reviews (Table 5) Destination: subsection.4.8 Item: Title: Strengths and Limitations Destination: subsection.4.9 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature Author: David Oliver-Gutierrez, Elena Ros-Sanchez, Gloria Segura-Duch, Tirso Alonso, Miguel Ángel Arcediano, Alejandra Herranz-Cabarcos, Jessica Matas, Roberto Castro Seco, R. L. P. van der Veen, Anna Boixadera, José García-Arumí and Joan Oliveres Subject: 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. 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