GANGRENE OF THE SKIN

To the Editor:—  I was much interested in the editorial in The Journal, May 29, on progressive postoperative bacterial synergistic gangrene of the skin caused by the synergistic action of the nonhemolytic micro-aerophilic streptococcus and Staphylococcus aureus. This condition has been frequently confused with the chronic undermining burrowing ulcers in which the hemolytic micro-aerophilic streptococcus is the sole causative organism.A number of articles have appeared which have confused these two conditions and it is important to differentiate clearly between them. In both, zinc peroxide is now an established method of treatment after excision, as I stated in a paper that appeared in the Surgical Clinics of North America in June 1936. In the gangrenous cases, wide excision is essential and recovery will occur after excision alone, but zinc peroxide prevents recurrence, hastens the healing and permits skin grafting earlier than would otherwise be the case. In the undermining ulcer type, excision is sometimes not necessary because there is no gangrene, and frequently zinc peroxide can be brought into close apposition with the surface of the infection without extensive operation.