Introduction

Despite the impression that may have been gained from the British media, necrotising soft tissue infections have been recognised and reported for centuries, the earliest dating back to Hippocrates in the 5th century BC.1 Such infections represent a large spectrum of clinical entities, ranging from mild pyodermas to life threatening necrotising fasciitis. Although these infections are most commonly caused by streptococcal and staphylococcal species, a multitude of other organisms have also been implicated.2

The term necrotising fasciitis was first used by Wilson3 in 1952 to describe the most consistent feature of the infection, necrosis of the fascia and subcutaneous tissue with relative sparing of the underlying muscle. It can progress rapidly to systemic toxicity and even death if not promptly diagnosed and treated. Once suspected, management should consist of immediate resuscitation, early surgical debridement, and administration of broad spectrum intravenous antibiotics.

As plastic surgeons, we receive several referrals each year from other specialties to diagnose or exclude the possibility of necrotising fasciitis. Since it is part of a spectrum of necrotising soft tissue infections, diagnosis can certainly be difficult for people who are unfamiliar with the condition and treatment may be delayed. This may be compounded by the relative lack of clinical signs and symptoms during the early course of the infection and because surgical consultation is sought only once the diagnosis is obvious and the signs of sepsis are readily apparent. Unfortunately, most adverse outcomes result from this delay in diagnosis.4

Fortunately, necrotising fasciitis is rare. The actual incidence in the United Kingdom is estimated at 500 new cases each year but is difficult to record. This in part is due to the confusion …