Abstract
Periorbital necrotising fasciitis is a rare life-threatening presentation. We present a case of an 87-year-old patient with periorbital necrotising fasciitis. The patient was successfully managed by prompt diagnosis, debridement and reconstruction with a thick split thickness skin graft harvested from the scalp. To the best of our knowledge, this is the first case report in literature suggesting the use of sheet skin grafts from the scalp in reconstruction of necrotising fasciitis. The patient was discharged after 20 days and has no residual corneal or scleral show despite losing bilateral upper and lower eyelid skin. We present the case with photographs of initial presentation, debridement, and final reconstruction.
Reconstruction of post-debridement necrotising fasciitis offers a challenge to the plastic surgeon. The wound bed is not ideal and commonly colonised. We suggest the use of thick split thickness skin grafts harvested from the scalp. Despite their utility in burns surgery, the use of scalp split thickness skin is not documented in literature for reconstruction of necrotising fasciitis. We believe this type of skin graft offers multiple advantages: higher rate of graft takes, less contracture and inconspicuous donor site morbidity. Time to reconstruction is particularly important in patients with eye lid skin loss and we believe this type of skin graft offers a versatile solution when graft take is essential.
Split Thickness Skin Grafts (STSG): Approach in necrotising fasciitis, a rare case report