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Necrotising fasciitis
715
Letters to the Editor well tolerated by the patient. The results we have obtained from our small study have thus far been very encoura$ng. WC wi:;h to thank MS Josephine Chow. Head of the Department of Rehabilitation Medicine for providing the perforated Aquaplast” for the study, and Ms Pauline Tan for the sec~retarial support. Your5 faithfull\. T. C. Lb, FRCS. Nitin Mokal, MS (Plastic Surgery), Walter T. L. Tan, FRCS, Division of Plastic Surgery. Department of Surgery. National Ilniwrstty Hospital.
Lower K#:nt Ridge Road. Singapors: 051 I
Reftrences I McC‘lrth!
JG. M’ood-Smith D. Rhinoplasty. In: McCarthy JG. cd. Plastic Surger! Vol 3. The Face Part 2. Philadelphia: WE Sannder\ Co I YW: I X?il-5.
An important and earlv sign 01‘ undcrllmg I;isciitih that the authors fail to meniion is that ot’ reduced pinprick sensation over the affected area of skin.” This sign precedes the development of frank gangrene and thus debridcmcnt at this stage may be more conservative. Once the tissues are opened. the presence of fasciitis can be conlirmtd. and linger dissection used to determine the limits of undermining. A number of causative organisms ha\-e been implicated in nccrotising fasciitis. which is usually due to miscd infection. In cervicofacial cases. the combination of a \ iridans %trcptococcus and an anaerobic organism has been reported frequently and initial antibiotic therapy should take this into account whilst awaiting confirmation by hacteriolo~ical examination.’ Furthermore. the uhe of frozen suction blnpsies in addition to conventional microbiological samptcs has been recommended as a method that permits early diagnosis of this condition. leading to a reduction in mortality. This paper esemplities the problems of duplication ol material which may occur in the medical literature. particularly among the many diffeerent specialist journals. It hIghlights the need for meticulous care when performing literature searches and underlines the need to consider othcl specialties and their journals as a source of int‘ormation on conditions that are not frequent11 cncountercd in one‘s ou II practice. Yours faithfull>.
Necrotising
fasciitis
Sir.
Necrotising Fasciitis in the head and neck region. Maqbool. M.. Ahmad. R.. Ahmed. R., Qazi. S. British Journal of Plastic Surgery. 45. 38 1. We have read with interest the case report by Maqbool c’r(II.’ and feel that while it may be a valuable addition to the existing body of knowledge on this condition. certain points raised bq the authors should be addressed. While undoubtedly necrotising fasciitis affects the head and neck region less frequently than other sites. we must disagree with the authors’ statement that “no case with head and neck involvement has been reported so far”. It is certainly not as uncommon as suggested by this statement. and such casts have indeed been reported in the relevant specialist Journals. We would respectfully draw the authors’ attention to an excellent review of 27 cases of cervicofacial necrotising fasciitls by Balcerak c’f (I/.~ Indeed. both maxillofacial and otorhinolaryngology journals contain numerous reports of head and neck involvement in this condition.
Nicholas M. Whear, MBBS, FDSRCS. FRCS. Senior Registrar. Department of Maxillofacial Surgery. Richard R. J. Cousley. BSc, BDS, House Oficcr, Department of M;lxillofacial St. Thomas’ Hospital. Lambeth Palace Road. London SEI 7EH
Surgery.
References I. Maqhool M. Ahmad R. Ahmed R. Qar~ S kecrotiaing 2.
3. 4. 5.
tasclitlr in the head and neck regwn. British Journ, of Pl;t\tic Surger\ lYY2: 15: 1x1. Balcerak RJ. Slsto JM. Bosack RC C’er\wllaaal neclotihmg fasciitia: Report ol three cases xnd literature rc\ww. Jonrn;~l of Oral and Mauillofac~al Surgery IY)t;X:Jh- _(iO. Wilson B. Necrotising fasciitis. The Amenc;~n Surgeon lY52, IX: 416. Steel 4. An unusual case ofnecrotising fiwlltis. Brltlsh Journal of Owl and Maxillofacial Surger! 1987: 75. 32s. S~amenkovic 1. Lew PD. Early rcco@lo,rl ol’potentially fatal necrotisinp fasciitis. The use of fro/en wct11)n biopsy. The Neu England Journal ol Medicine IYYJ, 7 IO 16X9
Letters to the Editor well tolerated by the patient. The results we have obtained from our small study have thus far been very encoura$ng. WC wi:;h to thank MS Josephine Chow. Head of the Department of Rehabilitation Medicine for providing the perforated Aquaplast” for the study, and Ms Pauline Tan for the sec~retarial support. Your5 faithfull\. T. C. Lb, FRCS. Nitin Mokal, MS (Plastic Surgery), Walter T. L. Tan, FRCS, Division of Plastic Surgery. Department of Surgery. National Ilniwrstty Hospital.
Lower K#:nt Ridge Road. Singapors: 051 I
Reftrences I McC‘lrth!
JG. M’ood-Smith D. Rhinoplasty. In: McCarthy JG. cd. Plastic Surger! Vol 3. The Face Part 2. Philadelphia: WE Sannder\ Co I YW: I X?il-5.
An important and earlv sign 01‘ undcrllmg I;isciitih that the authors fail to meniion is that ot’ reduced pinprick sensation over the affected area of skin.” This sign precedes the development of frank gangrene and thus debridcmcnt at this stage may be more conservative. Once the tissues are opened. the presence of fasciitis can be conlirmtd. and linger dissection used to determine the limits of undermining. A number of causative organisms ha\-e been implicated in nccrotising fasciitis. which is usually due to miscd infection. In cervicofacial cases. the combination of a \ iridans %trcptococcus and an anaerobic organism has been reported frequently and initial antibiotic therapy should take this into account whilst awaiting confirmation by hacteriolo~ical examination.’ Furthermore. the uhe of frozen suction blnpsies in addition to conventional microbiological samptcs has been recommended as a method that permits early diagnosis of this condition. leading to a reduction in mortality. This paper esemplities the problems of duplication ol material which may occur in the medical literature. particularly among the many diffeerent specialist journals. It hIghlights the need for meticulous care when performing literature searches and underlines the need to consider othcl specialties and their journals as a source of int‘ormation on conditions that are not frequent11 cncountercd in one‘s ou II practice. Yours faithfull>.
Necrotising
fasciitis
Sir.
Necrotising Fasciitis in the head and neck region. Maqbool. M.. Ahmad. R.. Ahmed. R., Qazi. S. British Journal of Plastic Surgery. 45. 38 1. We have read with interest the case report by Maqbool c’r(II.’ and feel that while it may be a valuable addition to the existing body of knowledge on this condition. certain points raised bq the authors should be addressed. While undoubtedly necrotising fasciitis affects the head and neck region less frequently than other sites. we must disagree with the authors’ statement that “no case with head and neck involvement has been reported so far”. It is certainly not as uncommon as suggested by this statement. and such casts have indeed been reported in the relevant specialist Journals. We would respectfully draw the authors’ attention to an excellent review of 27 cases of cervicofacial necrotising fasciitls by Balcerak c’f (I/.~ Indeed. both maxillofacial and otorhinolaryngology journals contain numerous reports of head and neck involvement in this condition.
Nicholas M. Whear, MBBS, FDSRCS. FRCS. Senior Registrar. Department of Maxillofacial Surgery. Richard R. J. Cousley. BSc, BDS, House Oficcr, Department of M;lxillofacial St. Thomas’ Hospital. Lambeth Palace Road. London SEI 7EH
Surgery.
References I. Maqhool M. Ahmad R. Ahmed R. Qar~ S kecrotiaing 2.
3. 4. 5.
tasclitlr in the head and neck regwn. British Journ, of Pl;t\tic Surger\ lYY2: 15: 1x1. Balcerak RJ. Slsto JM. Bosack RC C’er\wllaaal neclotihmg fasciitia: Report ol three cases xnd literature rc\ww. Jonrn;~l of Oral and Mauillofac~al Surgery IY)t;X:Jh- _(iO. Wilson B. Necrotising fasciitis. The Amenc;~n Surgeon lY52, IX: 416. Steel 4. An unusual case ofnecrotising fiwlltis. Brltlsh Journal of Owl and Maxillofacial Surger! 1987: 75. 32s. S~amenkovic 1. Lew PD. Early rcco@lo,rl ol’potentially fatal necrotisinp fasciitis. The use of fro/en wct11)n biopsy. The Neu England Journal ol Medicine IYYJ, 7 IO 16X9