Intended for healthcare professionals

Rapid response to:

Clinical Review

Necrotising fasciitis

BMJ 2005; 330 doi: (Published 07 April 2005) Cite this as: BMJ 2005;330:830

Rapid Response:

Necrotising Fasciitis: Always use the finger.

Re: Clinical review - Necrotising fasciitis

We read this recent article with interest and we feel that the
authors have omitted a valuable diagnostic tool. The need for surgical
debridement in these patients is based upon the diagnosis of tissue or
fascial necrosis. This is most easily diagnosed by a combination of visual
inspection and digital examination of the tissue. The 'Finger Test' is an
established, quick and easy method for doing this.(1,2) The test can be
easily carried out in the A&E, the ward or theatre under local or
general aneasthesia.

The traditional method is to make a test incision in the suspect area
of approximately 2cm once anaesthesia has been applied. The tissues can
then be examined visually. The absence of normal blood flow, dirty
'dishwater' coloured fluid and discolouration of the fat would favour the
diagnosis. A rapid finger sweep at the level of the fascia can then be
carried out. If the tissues dissect with minimal resistance this again
favours the diagnosis and the need for formal debridement. Fluid and
tissue samples can also be obtained at this stage for microbiological

The authors have stressed in the article the need for a high index of
suspicion in making the diagnosis and subsequent institution of rapid
treatment. In our unit we routinely use the 'Finger Test' to confirm or
refute the diagnosis in any case where we have a high index of suspicion
and we promote its value in confirming the diagnosis.


1. Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-
tissue injury: diagnosis and management of necrotizing fasciitis and
purpura fulminans.[see comment]. Plastic & Reconstructive Surgery
2001: 107: 1025-35.

2. Childers BJ, Potyondy LD, Nachreiner R, et al. Necrotizing fasciitis: a
fourteen-year retrospective study of 163 consecutive patients. American
Surgeon 2002: 68: 109-16.

Competing interests:
None declared

Competing interests: No competing interests

21 April 2005
Richard R Clark
Research Fellow
David J McGill
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G31 2ER