BMJ 1994;309:737-738 (17 September)

Letters

Necrotising fasciitis Use of skin flaps needs experience

EDITOR, - H Cox and colleagues seem to misunderstand the circulation of the skin.1 The primary problem in necrotising fasciitis relates not just to the underlying fascia but also to the subcutaneous tissues. Any plastic surgeon will have seen cases in which the underlying subcutaneous tissues become necrotic. When this dead tissue is excised the skin above becomes necrotic because the feeding blood supply based on the fasciocutaneous perforated system has been removed. If excision of the necrotic tissue is adequate it will include both the fascia and the subcutaneous tissue, which leaves the skin to survive only on its dermal vascular network. The length and breadth of the pedicle are therefore severely compromised, particularly in areas where fasciitis is most common (the groin, perineum, abdomen, and leg).

It is therefore dangerous to suggest the use of skin flaps by those who are not experienced or trained in the technique. . . . [Full text of this article]


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Relevant Article

Necrotising fasciitis Immediate surgical opinion is essential
R G Ward, H Cox, J A S Carruth, S R Williams, and A P Brightwell
BMJ 1994 309: 341-342. [Extract] [Full Text]

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