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  • Title: 'Stalled' periocular necrotising fasciitis: early effective treatment or host genetic determinants?
    Author: Mutamba A, Verity DH, Rose GE.
    Journal: Eye (Lond); 2013 Mar; 27(3):432-7. PubMed ID: 23412558.
    Abstract:
    BACKGROUND: Necrotising fasciitis (NF) is a devastating disease with considerable mortality and morbidity, and early aggressive surgical debridement of devitalised necrotic tissues has traditionally been advocated. METHODS: We describe three patients who were referred from other units several weeks after developing periocular necrotising fasciitis; in all the three, the disease had been managed medically without surgical debridement, with apparent 'stalling' of the inflammatory process despite persistent necrotic periocular tissue. RESULTS: Following 'elective debridement' of the devitalised tissues and reconstruction with local flaps, all achieved a satisfactory aesthetic result. DISCUSSION: The role of host genetic determinants, polarised cytokine responses, and early, effective medical treatment in patients with atypical 'disease phenotypes' in NF are discussed.
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