As a reviewer, there is always a temptation to select those articles in which one has a particular interest and to review them, rather than those which may very well deserve a review, but are outside one’s personal experience. So I must confess that I have latched on to this article because one of my earliest publications (in 1976) was a case report on necrotising fasciitis. Reading this article now, it would appear that in just under 40 years, not much has changed! Necrotising fasciitis, for all its prominence in the tabloid newspapers as ‘flesh eating disease’, is still difficult to diagnose and if a diagnosis is not made early and surgical debridement carried out adequately, the prognosis is still fatal. As an aid to diagnosis, the authors of this paper have listed the laboratory risk indicator for necrotising fasciitis (LRINEC), although they suggest that this may be insufficiently sensitive to make a definite diagnosis in the early stages. A measurement of the serum lactate on admission is quoted as the most useful adjunct to a physical diagnosis, but a high index of suspicion and a familiarity with the problem would still appear to be the most important factors in making the correct diagnosis and articles such as this are important in keeping this condition in the front of the mind.
Update on necrotising fasciitis
Reviewed by Martyn Webster
Analysis of the increasing prevalence of necrotising fasciitis referrals to a regional plastic surgery unit: A retrospective case series.
