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452 British Journal of Plastic Surgery Figure 2~-Radiograph of the thumb revealing a snake fang embedded in the soft tissues adjacent to the MCPJ. Figure 3~The retrieved snake fang adjacent to a millimetre ruler. Yours faithfully, C. M. O'Brien FRCS, Senior House Officer Plastic Surgery S. Heppell FRCS, Senior House Officer Plastic Surgery U. Khan FRCS, Specialist Registrar Plastic Surgery H. J. C. R. Belcher MS, FRCS(Plast), Consultant Plastic Surgeon The Queen Victoria Hospital NHS Trust, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK. Reference 1. Jagannathan M, Babu ND, Saple A, Nayak BB. Deadly perfec- tion of nature - can we ever duplicate it? Br J Plast Surg 2000; 53: 176. doi: 10.1054/bjps.2000.3373 Use of Flamazine cream to reduce infection following skin grafting Sir, We would like to bring to your attention the use of Flamazine cream as a topical antiseptic on skin grafts at the time of application. This is of particular use when the graft- ing is to be carried out on infected areas such as delayed grafting of burns, pressure sores, hidradenitis, leg ulcers and in perineal wounds such as those following Fournier's gangrene. The senior author has used it for several years without any detrimental effect. Flamazine cream provides a moist environment for the graft, but has not resulted in any macer- ation or devitalisation of the graft. We have found it espe- cially useful to combat infection by pseudomonas or in the presence of indeterminate bacterial flora. This cream is not used if the graft is being applied to a clean wound surface without any evidence of infection, however, in circumstances where a frank infection has been present or is expected this cream has been found very useful. We have carried out a literature search going back to 1966 using Medline and we could not find any report which high- lights the use of Flamazine cream at the time of skin graft- ing. We have also not encountered any other plastic surgeons using this technique and we would like to share this with your readers. We are aware that Flamazine cream does have several reported side effects, both systemic and local. However, it is in widespread use, is an effective local anti- bacterial agent and is economical and widely available. We find that this is a useful technique when applying a skin graft in circumstances less than ideal. We would further like to add that we have used this both with sheet and mesh grafts and there seems to be no difference. Yours faithfully, Shekhar Srivastava FRCS, Consultant Plastic Reconstructive and Hand Surgeon S. Wharton MPhil, FRCS, Specialist Registrar in Plastic Surgery George Eliot Hospital, College Road, Nuneaton CV10 7D J, UK, doi: 10.1054/bjps.2000.3374 Incomplete excision of rodent ulcers - management decisions Sir, I read with great interest the excellent paper by Richard Griffiths on recommendations for management by re-exci- sion and congratulate him on his extensive personal study. 1 While agreeing with many of his conclusions and recommen- dations, I feel I should comment further. Personally, I disagree that in every patient an incomplete excision must be followed up by a further procedure. Bearing in mind that, as a rule, basal cell carcinomas are slow growing
