title: Saltwater nectotizing fasciitis following coral reef laceration possibly exacerbated by a long-haul flight: a case report.
abstract: BACKGROUND
  Necrotising fasciits is a rapidly progressive disease characterised by extensive necrosis of the fascia, skin, and subcutaneous tissue, with relative sparing of the underlying muscle.
  
  
  METHODS
  We present the case of a 24-year old Irish male student who sustained a laceration to his right shin from contact with a coral reef while swimming in the Phuket region, off the west coast of Thailand. The following day, he returned to Ireland and presented with an aggressive and destructive variant of group A beta-hemolytic streptococcal necrotising fasciitis originating at the site of the coral reef injury, and exacerbated by the long-haul flight. He was successfully treated with aggressive surgical debridement, vacuum-assisted dressings, split skin grafting and broad spectrum antibiotics.
  
  
  CONCLUSIONS
  Necrotising fasciitis can progress rapidly to systemic toxicity and even death without expedient diagnosis and aggressive treatment. Long-haul flights induce significant fluid accumulation in the lower extremity. These physiological fluid shifts may have contributed to the severity of our patient's necrotizing condition following his flight from Thailand.
authors.affiliation: Department of Orthopaedics, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
authors.forename: Ann-Maria
authors.initials: AM
authors.lastname: Byrne
authors.forename: Paul
authors.initials: P
authors.lastname: Sullivan
authors.forename: Peter
authors.initials: P
authors.lastname: Keogh