A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Studies Selection
3.2. Patient and Necrotizing Fasciitis Features (Table 2)
3.3. Treatment (Table 3)
3.4. Outcome (Table 3)
3.5. Comparative Analysis
4. Discussion
4.1. Incidence
4.2. Pathophysiology
4.3. Diagnosis
4.4. Risk Factors
4.5. Etiology
4.6. Treatment
4.7. Outcome
4.8. Other Reviews (Table 5)
4.9. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Authors (Year) | N | Age (Range) | Sex | Vision Loss * | Septic Shock | Death |
---|---|---|---|---|---|---|
Franzen et al. (2013) [8] | 1 | 31 | M | Not affected | No | No |
Saonanon et al. (2013) [9] | 1 | 48 | M | Not affected | No | No |
Shah et al. (2013) [10] | 1 | 22 | M | Not affected | No | No |
Richir et al. (2013) [11] | 1 | 43 | F | Not affected | Yes | No |
Mehta et al. (2013) [12] | 1 | 57 | F | Not affected | No | No |
Rodríguez-González et al. (2013) [13] | 1 | 53 | M | Blindness | No | No |
Shield et al. (2013) [14] | 5 | 55.6 (42–62) | 3F, 2M | 1 Not affected 4 Blindness | 2 Septic Shocks | No |
Arazi et al. (2023) [15] | 1 | 66 | F | Affected | Yes | No |
Mutamba et al. (2013) [16] | 3 | 67 (57–76) | 1F, 2M | All not affected | No | No |
Casey et al. (2014) [17] | 1 | 46 | M | Not affected | Yes | No |
Contreras-Ruiz (2014) [18] | 2 | 53 (48–58) | M | Not affected | No | No |
Gelaw et al. (2014) [19] | 1 | 33 | F | - | No | - |
Günel et al. (2014) [20] | 1 | 75 | M | Not affected | No | No |
Brissette et al. (2014) [21] | 1 | 34 | M | Not affected | No | No |
Yau et al. (2015) [22] | 1 | 2 | M | Not affected | No | No |
Khurana et al. (2015) [23] | 6 | 8 m (5–11 m) | 2F, 4M | - | No | No |
Jain et al. (2015) [24] | 1 | 6 | M | - | Yes | No |
Abdul Kadir et al. (2016) [25] | 1 | 72 | M | - | Yes | Yes |
Hagiya et al. (2016) [26] | 1 | 62 | F | Blindness | Yes | No |
Danan et al. (2016) [27] | 1 | 50 | M | - | No | No |
Wolkow et al. (2017) [28] | 1 | 64 | M | Not affected | No | No |
Uhrich et al. (2017) [29] | 1 | 64 | F | - | Yes | Yes |
Singam N et al. (2017) [30] | 1 | 60 | F | Not affected | No | No |
Sultan et al. (2017) [31] | 1 | 50 | M | Blindness | No | No |
Zhang et al. (2017) [32] | 1 | 56 | M | Not affected | No | No |
Eiben & Rodriguez-Villar (2018) [33] | 1 | 60 | M | Not affected | Yes | No |
Leach et al. (2018) [34] | 1 | 70 | M | Not affected | No | No |
Leonardo et al. (2018) [35] | 1 | 55 | F | Not affected | No | No |
Jaffer et al. (2018) [36] | 1 | 51 | F | Not affected | Yes | No |
Gillespie et al. (2018) [37] | 1 | 44 | M | Not affected | No | No |
Proia (2018) [38] | 1 | 1 | M | - | No | No |
Herdiana et al. (2018) [39] | 1 | 69 | F | Not affected | Yes | No |
Olsson et al. (2018) [40] | 1 | 12 | M | Not affected | No | No |
Deneubourg et al. (2018) [41] | 1 | 30 | F | Not affected | Yes | No |
Setiawati et al. (2018) [42] | 1 | 4 | F | Blindness | Yes | No |
Park et al. (2019) [43] | 1 | 53 | F | - | 1 | No |
Bermudez & Walsh (2019) [44] | 1 | 58 | F | - | No | No |
Karan et al. (2019) [1] | 1 | 81 | F | - | Yes | Yes |
Cozzupoli (2019) [45] | 1 | 70 | F | - | Yes | Yes |
Tong et al. (2019) [46] | 1 | 51 | M | Not affected | No | No |
Placinta et al. (2019) [47] | 1 | 80 | F | Not affected | Yes | No |
Cereceda-Monteoliva et al. (2019) [48] | 1 | 56 | M | - | Yes | No |
Nadal et al. (2019) [49] | 1 | 32 | F | Not affected | No | No |
Sud et al. (2019) [50] | 1 | 52 | F | - | No | No |
Mehraban et al. (2019) [51] | 1 | 51 | F | - | Yes | No |
Landeen et al. (2020) [52] | 1 | 58 | F | Affected | No | No |
McCabe et al. (2020) [53] | 1 | 56 | F | Not affected | Yes | No |
Kontou et al. (2020) [54] | 1 | 42 | M | Not affected | No | No |
Negi et al. (2020) [55] | 1 | 32 | M | Affected | No | No |
Muthie et al. (2020) [56] | 1 | 42 | F | Not affected | No | No |
Compton et al. (2020) [57] | 1 | 44 | F | Not affected | Yes | No |
Würtz et al. (2020) [58] | 6 | 55.8 (37–85) | 4F, 2M | 1 Not affected 3 Blindness 2 - | 2 Septic Shocks | No |
Ting et al. (2020) [59] | 1 | 35 | F | Not affected | No | No |
Pereira et al. (2021) [60] | 1 | 66 | F | Not affected | Yes | No |
Lee et al. (2021) [61] | 1 | 62 | M | Blindness | No | No |
Cameron et al. (2021) [62] | 1 | 25 | F | Affected | Yes | No |
Zhou et al. (2021) [63] | 1 | 59 | M | Not affected | No | No |
Haque et al. (2021) [64] | 2 | 65 (62–68) | 1F, 1M | Blindness - | No | No |
Yazici et al. (2021) [65] | 1 | 70 | M | Blindness | No | No |
Reddy et al. (2021) [66] | 1 | 44 | M | Not affected | Yes | No |
Rossetto et al. (2021) [67] | 1 | 68 | M | Not affected | No | No |
Tartar et al. (2022) [68] | 1 | 33 | M | Not affected | No | No |
Silverman et al. (2022) [69] | 1 | 21 | M | Not affected | No | No |
Kakimoto et al. (2022) [70] | 1 | 55 | F | - | No | No |
Suh et al. (2022) [71] | 1 | 43 | M | Not affected | No | No |
Mosenia et al. (2022) [72] | 1 | 39 | M | Blindness | No | No |
Gaur et al. (2023) [73] | 1 | 35 | M | Not affected | Yes | No |
Hadizamani et al. (2023) [74] | 1 | 69 | M | - | Yes | No |
Ang et al. (2023) [75] | 1 | 33 | F | Not affected | No | No |
Schuh et al. (2023) [76] | 5 | 71 (65 to 83) | 5M | 4 Not affected 1 Blindness | 4 Septic Shocks | No |
Huang et al. (2023) [77] | 1 | 26 | M | Not affected | No | No |
Pertea et al. (2023) [78] | 1 | 67 | M | Blindness | Yes | No |
Oliver-Gutierrez et al. (2024) [79] | 9 | 67 (41 to 82) | 5F, 4M | 6 Not affected 2 Affected 1 Blindness | 2 Septic Shocks | No |
Arun et al. (2024) [5] | 2 | 66 (52 to 69) | 2M | 2 Affected | 1 Septic Shocks | No |
Blanchard et al. (2024) [80] | 1 | 75 | M | Not affected | No | No |
Hojjatie et al. (2024) [81] | 1 | 79 | F | Affected | No | No |
Totals only individualized data: | 107 | Median 55.5 (8 m–85 y) Mean 50.9 (SD 22.3) | 46F, 61M | 56 (67.5%) Not affected 8 (9.6%) Affected 19 (22.9%) Blindness | 38 Septic Shocks (35.5%) | 4 (3.8%) |
Wladis et al. (2015) [82] | 17 | 48.1 | 8F, 9M | 9 Not affected 5 Affected 3 Blindness | No | 1 Death |
Flavahan et al. (2014) [83] | 30 | 68 | 17F, 13M | 15 Not affected 9 Affected 2 Blindness 4 - | 5 Septic Shocks | 3 Death |
Rajak et al. (2016) [4] | 29 | 56 | 9F, 20M | 24 Not affected 4 Blindness 1 - | 6 Septic Shocks | 1 Death |
Totals with pooled data: | 183 | Mean 54.2 | 80F, 103M | 104 (67.5%) Not affected 22 (14.3%) Affected 28 (18.2%) Blindness | 49 Septic Shocks (26.8%) | 9 (4.9%) |
Individualized Data (107) | Pooled Data (183) | |||
---|---|---|---|---|
n | % | n | % | |
Cause | 99 | 174 | ||
Spontaneous | 42 | 42.4% | 72 | 40.8% |
Wound or surgery a | 38 | 38.4% | 78 | 44.8% |
Sinusitis | 9 | 9.1% | 9 | 5.2% |
Other skin infections b | 10 | 10.1% | 16 | 9.2% |
Comorbidities | 107 | 183 | ||
DM | 19 | 17.6% | - | |
AHT (Arterial hypertension) | 16 | 15.0% | - | |
Alcoholism or cirrhosis | 23 | 21.5% | - | |
Inmonusppressed c | 52 | 48.6% | 90 | 49.6% |
No comorbidities d | 38 | 35.9% | - | |
Pathogen e | 100 | 158 | ||
S. pyogenes | 74 | 74.0% | 126 | 79.8% |
S. aureus | 18 | 18.0% | 24 | 15.2% |
Pseudomona aureginosa | 4 | 4.0% | 7 | 4.4% |
Klebsiella pneumoniae | 3 | 3.0% | 3 | 1.9% |
Other | 13 | 13.0% | 14 | 8.9% |
Laterality | 99 | 129 | ||
Unilateral | 73 | 73.7% | 93 | 72.1% |
Bilateral | 26 | 26.3% | 36 | 27.9% |
Extraocular | 100 | 159 | ||
Limited to periocular region | 59 | 59.0% | 87 | 54.7% |
Facial involvement | 41 | 41.0% | 73 | 45.3% |
Orbital extension | 87 | 100 | ||
Preseptal | 45 | 51.7% | 54 | 54.0% |
Postseptal | 42 | 48.3% | 46 | 46.0% |
Individualized Data | Pooled Data | |||
---|---|---|---|---|
n | % | n | % | |
Treatment | ||||
Surgical | 107 | 183 | ||
No debridement | 4 | 3.7% | 19 | 10.4% |
Single debridement | 70 | 65.4% | 108 | 59.0% |
Serial debridements | 33 | 30.8% | 56 | 30.6% |
Exenteration/enucleation | 12 | 11.2% | 16 | 8.7% |
Other medical therapies | 107 | 183 | ||
Immunoglobulin | 4 | 3.7% | 3 | 1.6% |
HBOT | 5 | 4.6% | 6 | 3.3% |
NPWT | 5 | 4.6% | 5 | 2.7% |
Outcome | ||||
Vision | 83 | 154 | ||
Not affected | 56 | 67.5% | 104 | 67.5% |
Affected | 8 | 9.6% | 22 | 14.3% |
Blindness | 19 | 22.9% | 28 | 18.2% |
Septic Shock | 38 | 35.5% | 49 | 26.8% |
Death | 4 | 3.8% | 9 | 4.9% |
Serial Debridement | Blindness | Septic Shock | Death | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
0 or 1 Debridement | >1 Debridement | p Value | Severe Loss | No Severe Loss | p Value | No | Yes | p Value | No | Yes | p Value | |||||||||
Age | 53.3 (21.9) | 45.3 (22.6) | 0.083 | 57.0 (17.8) | 53.1 (18.8) | 0.43 | 46.7 (22.8) | 58.4 (19.4) | 0.009 | 50.2 (22.4) | 71.8 (7.0) | 0.058 | ||||||||
Sex (Female) | 31 (42%) | 15 (45%) | 0.73 | 10 (53%) | 24 (38%) | 0.24 | 26 (38%) | 20 (53%) | 0.14 | 42 (41%) | 3 (75%) | 0.20 | ||||||||
Immunosuppression | 36 (49%) | 16 (48%) | 0.99 | 12 (63%) | 28 (44%) | 0.14 | 31 (45%) | 21 (55%) | 0.31 | 48 (47%) | 4 (100%) | 0.05 | ||||||||
DM | 15 (20%) | 4 (12%) | 0.31 | 4 (21%) | 8 (12%) | 0.35 | 12 (17%) | 7 (18%) | 0.89 | 15 (15%) | 3 (75%) | 0.015 | ||||||||
Extraocular affection | 24 (36%) | 17 (52%) | 0.13 | 6 (40%) | 26 (42%) | 0.89 | 25 (38%) | 16 (46%) | 0.48 | 37 (39%) | 4 (100%) | 0.027 | ||||||||
TOTALS | 74 | 33 | 19 | 64 | 69 | 38 | 103 | 4 |
Lazzeri et al. [3] | Amrith et al. [2] | This Work | |
---|---|---|---|
Year | 2009 | 2013 | 2025 |
N | 103 | 94 | 183 |
Years reviewed | 1950 to 2008 | 1993 to 2012 | 2013 to 2024 |
Age (median and range) | 50.2 (17 m–93 y) | 46.3 (0.1–83 y) | 54.2 (8 m–85 y) |
Group A beta-hemolytic Streptococcus | 68% | 51.1% | 79.8% |
Facial involvement | - | 42.6% | 45.3% |
Debridement | - | 85.1% | 89.6% |
Blindness | - | 13.8% | 18.2% |
Septic shock | - | 30.9% | 27.2% |
Death | 14.42% | 8.5% | 4.9% |
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Oliver-Gutierrez, D.; Ros-Sanchez, E.; Segura-Duch, G.; Alonso, T.; Arcediano, M.Á.; Herranz-Cabarcos, A.; Matas, J.; Castro Seco, R.; van der Veen, R.L.P.; Boixadera, A.; et al. A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature. Diagnostics 2025, 15, 1181. https://doi.org/10.3390/diagnostics15091181
Oliver-Gutierrez D, Ros-Sanchez E, Segura-Duch G, Alonso T, Arcediano MÁ, Herranz-Cabarcos A, Matas J, Castro Seco R, van der Veen RLP, Boixadera A, et al. A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature. Diagnostics. 2025; 15(9):1181. https://doi.org/10.3390/diagnostics15091181
Chicago/Turabian StyleOliver-Gutierrez, David, 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, and et al. 2025. "A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature" Diagnostics 15, no. 9: 1181. https://doi.org/10.3390/diagnostics15091181
APA StyleOliver-Gutierrez, D., Ros-Sanchez, E., Segura-Duch, G., Alonso, T., Arcediano, M. Á., Herranz-Cabarcos, A., Matas, J., Castro Seco, R., van der Veen, R. L. P., Boixadera, A., García-Arumí, J., & Oliveres, J. (2025). A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature. Diagnostics, 15(9), 1181. https://doi.org/10.3390/diagnostics15091181