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# Upper Limb Nec Fasc on the Rise, 3 Necrotising Fasciitis Diagnoses, & the Debridement Drill
- URL: https://www.theplasticsfella.com/april-27th-2/
- Published: 2025-04-25T13:10:24.000Z
- Updated: 2025-04-26T21:05:07.000Z
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/april-27th-2/#a-letter-from-pfella)  
P'Fella on vacation mode!
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/april-27th-2/#the-sunday-quiz)  
How well do you know **necrotising fasciitis*?
3. 🖼️ [****Image of the Week**](https://www.theplasticsfella.com/april-27th-2/#image-of-the-week)  
Dishwater fluid in nec fasc
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/april-27th-2/#technique-tip)  
How to debride necrotising fasciitis.
5. ****🎈** [****Upcoming Events**](https://www.theplasticsfella.com/april-27th-2/#upcoming-events)  
New event added!
6. 🎓 [****JPRAS Journal Club**](https://www.theplasticsfella.com/april-27th-2/#jpras-journal-club)  
Epidemiology of upper limb necrotising fasciitis in England.
7. ****🚨** [****Case of the Week**](https://www.theplasticsfella.com/april-27th-2/#case-of-the-week)  
Nec fasc clinical scenario.
8. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/april-27th-2/#articles-of-the-week)  
LRINEC score, "3Ds" for diagnosing nec fasc, & a practical review of necrotising fasciitis: with 1-sentence summaries.
9. 💕 [****Feedback**](https://www.theplasticsfella.com/april-27th-2/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**P'Fella on Vacation!*

👋

****Hey Team!**  
  
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.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/4172ed28-190e-447b-b686-ae40dd14e82e.png)

P'fella on vacay-mode

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?*

****Are you ready to make it to the leaderboard?**  
  
Welcome to the ****next 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*

🖼️

****Image of the Week**   
  
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.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/bjs9371-fig-0004-m.jpg)

[Source](https://bjssjournals.onlinelibrary.wiley.com/doi/10.1002/bjs.9371?ref=theplasticsfella.com)

## Technique Tip

**How to Debride Necrotising Fasciitis*

🚑

****Technique Tip of the Week**   
  
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. 

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/Screenshot-2025-04-24-at-10-09-27.png)

[Source](https://pubmed.ncbi.nlm.nih.gov/18614147/?ref=theplasticsfella.com)

## Upcoming Events

**New Event Added!*

📅

****P’Fella’s event calendar** highlights the most impactful conferences, high-yield webinars, and carefully curated courses for you. You can also ****submit your event** and get it featured!  
  
We've just added some new events to our calendar; sign up below👇

## JPRAS Journal Club

**Epidemiology of Upper Limb Necrotising Fasciitis in England*

📑

****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).

[Epidemiology of Upper Limb Necrotising Fasciitis in England: A National Study (1998–2018)Data (1998-2018) from a UK study show upper-limb necrotising fasciitis tripled, then plateaued; 64 % of 728 patients were men and mostly from deprived areas. Despite surgery, 30- and 90-day mortality rates were 14 % and 16 %. Early diagnosis & action remain vital, especially in high-risk groups.![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/icon/Logo-Small-2-10.png)thePlasticsFellaPlasticsFella![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/thumbnail/Lunchtime-Lessons-3.png)](https://www.theplasticsfella.com/journal-upper-limb-necrotising-fasciitis/)

## Case of the Week

**Nec Fasc Clinical Scenario*

🚨

Our case of the week focuses on a high-stakes emergency: ****Necrotising fasciitis**.  
  
****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.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/04/Necrotising-Fasciitis---Clinical-Case.png) 

#### 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. 

[Read the Article](https://www.theplasticsfella.com/necrotising-fasciitis-clinical-scenario/) 

## Articles of the Week

**3 Interesting Articles with One-Sentence Summaries*

✅

****The LRINEC Score: A Lab-Based Tool for Early Detection of Necrotizing Fasciitis** ([Wong](https://pubmed.ncbi.nlm.nih.gov/15241098/?ref=theplasticsfella.com), 2004)   
  
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" for Diagnosing Necrotizing Fasciitis in Frontline Care** ([Haykal](https://www.jprasurg.com/article/S1748-6815%2823%2900270-X/abstract?ref=theplasticsfella.com), 2023)  
  
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.

✅

****Review of Necrotizing Fasciitis: Diagnosis, Surgical Principles, & Reconstructive Strategies** ([Guliyeva](https://journals.lww.com/prsgo/fulltext/2024/01000/practical%5Freview%5Fof%5Fnecrotizing%5Ffasciitis%5F.23.aspx?ref=theplasticsfella.com), 2024)  
  
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.

## Feedback

### I hope you enjoyed it 😄

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