Clinical concern for necrotising fasciitis: a review of referrals to plastic surgery units at two tertiary centres.

OBJECTIVES: To evaluate the impact of clinical suspicion on the diagnosis of necrotising fasciitis (NF) in two inpatient plastic surgery units. METHODS: A multicentre retrospective audit of all referrals of adult patients to the inpatient plastic surgery units of two Melbourne metropolitan tertiary centres from 1 February 2018 to 31 December 2018. RESULTS: A total of 53 patients (37 male, 16 female) were referred to evaluate for NF. There were 20 patients (37.04%) who underwent operative debridement. Of those, 15 were pre-operatively suspected of having NF and there were seven confirmed cases of NF (13.21%). Laboratory risk indicator for NF (LRINEC) score ≥ 6 had a statistically significant association with a diagnosis of NF (P = 0.03) and with operative debridement (P = 0.04). The incidence of NF in the cohort where the referrer had clinical concern for NF was 13.21% (P < 0.001) and when the referrer and the plastic surgeon suspected NF was 46.67% (P < 0.001). The number of patients needed to be referred for one case of NF to be diagnosed was 7.58. CONCLUSIONS: Clinical suspicion of NF is essential for diagnosis and clinicians who suspect NF should not hesitate to refer to the appropriate surgical unit. Prompt review is required of patients in whom NF is clinically suspected as these patients have a 13.21% incidence of NF. The laboratory risk indicator for NF score is not sufficiently specific nor sensitive to exclude or to diagnose NF as a stand-alone diagnostic tool but may have a role as an adjunct.

The influence of skin tears following collagenase treatment of Dupuytren's disease on treatment outcomes.

This study investigated influence of skin tears on patient-reported outcomes of injection of collagenase clostridium histolyticum for Dupuytren's disease and association between extension deficit of digits before injection and skin tear after the injection. From 2016 to 2018, 391 Dupuytren's cords were treated in 184 patients in a prospective cohort study and the patients were evaluated before injection and six months after injection. Skin tears occurred in 50% of these patients. We found no significant differences in the patient-reported outcomes between patients with or without skin tears. A higher extension deficit before treatment was associated with significantly increased frequency of skin tears. We conclude that the incidence of skin tears after injection does not affect patient reported outcomes six months after collagenase injection, but the incidence of skin tears is significantly associated with the severity of pre-treatment finger extension deficits.Level of evidence: II.