A severe case of periorbital necrotising fasciitis and successful management using Pelnac dermal substitute.

PurposePeriorbital necrotizing fasciitis (PNF) is a rare but potentially life-threatening condition requiring prompt intervention to balance tissue debridement and functional preservation.Case ReportWe present a 63-year-old female with bilateral PNF, rapid progression and cervical extension, requiring multiple debridements. Once the acute infective process was controlled, a dermal substitute was used in lieu of any local skin flaps or grafts in the upper eyelids, facilitating dermal regeneration. Despite extensive loss of adnexal tissue, the use of dermal substrate in the early reconstructive phase provided adequate ocular protection and allowed sufficient restoration of tissue to avoid any further surgery in the upper eyelids and to permit a modest lower eyelid repair.ConclusionsThis case highlights PNF's challenging management, requiring rapid intervention, novel reconstructive materials, and tailored surgical strategies. It underscores the potential for favourable outcomes even in severe cases through multidisciplinary care and early use of bioengineered dermal scaffolds.