Re: Necrotising fasciitis : Authors reply

14 September 2012

Thank you for the comments on our practice pointer article about necrotising fasciitis. The majority of responses to our article were around microbiological diagnosis and management. We were unaware of the work around the potential usefulness of immunoglobulin in managing this condition, this is unlikely ever to achieve more than level five evidence given the difficulties in conducting controlled trials in this area, but seems to have little harm and is biologically plausible. The focus of our article was on improving diagnosis promptly as this is where the greatest gains are. Discussing microbiological causation or operative management of the condition was not the main aim of the article. Trying to distinguish microbiological subtypes clinically is interesting, but the main pitfall in this condition is failure to consider the diagnosis at all. There are doubtful cases, especially early on in the disease process, where scoring systems and imaging may have a role, but fully agree that surgery should not be delayed once the diagnosis is made.

Competing interests: None declared

Adrian A Boyle, Emergency Physician

Helen Yasmin Sultan, Nicholas Shepherd

Cambridge University Foundation Hospitals Trust, Hill's Road, Cambridge, CB2 2QQ

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