Necrotising fasciitis Use of skin flaps needs experience

doi:10.1136/bmj.309.6956.737

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N Mercer

Bristol BS8 3BS
Royal South Hants Hospital, Southampton SO14 0YG.

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 …