As has been emphasised already this
is a clinical diagnosis and as soon as it is suspected surgical
exploration should be carried for confirmation. There are two tests
available to confirm the diagnosis; one clinical - the 'Finger Test' -
and one laboratory - frozen section pathology.
Some centres find the use of
frozen section pathology to be of use in confirming the diagnosis. It
should only be considered if immediately available and there exists
real doubt about the diagnosis. It should be noted that the
histological findings can only be considered to be 'consistent with the
diagnosis' and are not diagnostic. The diagnosis is made by history and
examination and confirmed by surgical
exploration. The histological features which are consistent with the
diagnosis
are:
- Necrosis of the superficial fascia
- Polymorphnuclear infiltration of the deep dermis and fascia
- Fibrinous thrombi of the arteries and veins passing through the
fascia
- Angiitis with fibrinoid necrosis of arterial and venous walls
- Presence of micro-organisms within the destroyed fascia and
dermis
(specimen stained with Gram's stain)
