In this week's edition
- ✍️ Letter from P'Fella
P'Fella on vacation mode! - 🤓 The Sunday Quiz
How well do you know necrotising fasciitis? - 🖼️ Image of the Week
Dishwater fluid in nec fasc - 🚑 Technique Tip
How to debride necrotising fasciitis. - 🎈 Upcoming Events
New event added! - 🎓 JPRAS Journal Club
Epidemiology of upper limb necrotising fasciitis in England. - 🚨 Case of the Week
Nec fasc clinical scenario. - 🔥 Articles of the Week
LRINEC score, "3Ds" for diagnosing nec fasc, & a practical review of necrotising fasciitis: with 1-sentence summaries. - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
P'Fella on Vacation!
No letter today as I’m officially on vacation mode. Shades on, drink in hand, and pretending I don’t know what “post-op day 5” means.
tk - instead of the ghibili style due to copyright issues, can we use either of these two images?
But while I’m away, let’s flip the script — I want to hear from you.
P’Fella ❤️
The Sunday Quiz
How Well Do You Know Necrotising Fasciitis?
tk - final round?
Welcome to the final round of The Weekly Quiz.
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.
Image of the Week
Dishwater Fluid in Nec Fasc
This week’s image shows a classic operative finding in necrotising fasciitis: The presence of dishwater fluid. A thin, grey, turbid exudate tracking along fascial planes. This sign reflects tissue liquefaction and bacterial spread. Early identification is critical as delayed debridement significantly increases morbidity and mortality.
📍Seen below: Undermined fascia, poor tissue perfusion, and hallmark dishwater fluid pooling in the fascial compartment.
Technique Tip
How to Debride Necrotising Fasciitis
This week’s tip focuses on the surgical approach to debriding necrotising fasciitis, using zone-based skin assessment to guide excision.
See image below for a breakdown of the technique.
Upcoming Events
New Event Added!
We've just added the 2025 International Residents World Cup to our calendar; sign up below👇
tk - couldn't add event
JPRAS Journal Club
Epidemiology of Upper Limb Necrotising Fasciitis in England
Upper limb necrotising fasciitis is rising in incidence, with a 250% increase from 1998 to 2013. Most cases affect males (64%) and socioeconomically deprived individuals. Despite surgical management, 30-day mortality is 14%, rising to 16% by 90 days. Early recognition and aggressive treatment remain crucial.
P'fella's educational fellow, Dr. Hatan Mortada explores the Epidemiology of Upper Limb Necrotising Fasciitis using a national study done in England over 20 years (1998-2018).
tk - add link after publishing
www.theplasticsfella.com/journal-upper-limb-necrotising-fasciitis/
Case of the Week
Nec Fasc Clinical Scenario
Learning Objectives:
1. Recognise pathognomonic signs of necrotising fasciitis.
2. Identify major risk factors.
3. Know which investigations aid diagnosis.
4. Formulate an urgent management plan.
5. Consider adjunctive therapies.
Clinical Scenario
A 45-year-old male arrives at the emergency department with severe pain in his right leg, which has increased in intensity over the past 24 hours. The leg is swollen, erythematous, and warm to the touch. There are also some dark, blistering areas on the skin.
The patient mentions a minor cut on his leg from gardening a few days ago. He has a history of poorly controlled diabetes mellitus type 2.
Parameters: Heart rate 145 bpm, Blood pressure 85/60, Temperature 38.4, Confused.
Primary Contributor: Dr Kurt Lee Chircop, Educational Fellow, Malta.
Reviewer: Dr Waraguru Wanjau, Educational Fellow, South Africa.
Articles of the Week
3 Interesting Articles with One-Sentence Summaries
The LRINEC score is based on routine labs like CRP & sodium and it flags necrotizing fasciitis with a 92% positive predictive value — a game-changer in distinguishing NF from cellulitis.
The “3Ds” of necrotizing fasciitis: Disproportionate pain, Dermatological signs, and Disorganized physiology, is a memorable triage tool that identified 66% of confirmed cases at presentation.
This practical review maps the full NF journey, highlighting the “4 Ds” of successful management: Diagnose early, Debride aggressively, Dress wisely, and Design the reconstruction to match the defect.
