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Aeromonas hydrophila infection of a scalp laceration (with synergistic gas-gangrene).

A 30-year-old man sustained a dirty irregular V-shaped laceration to the vertex of his scalp on diving head first into a freshwater pond. There was no associated injury or loss of conciousness. No fracture or foreign bodies were seen on the initial skull X-ray. The wound was cleaned and sutured at a nearby accident and emergency (A&E) department. Two days later he returned complaining of pain over the scalp wound. He was admitted to hospital and antibiotic treatment begun. Forty-eight hours later he was transferred to the local neurosurgical unit. By this time his scalp had become extensively cellulitic with surgical emphysema. The wound was oozing purulent material. He was pyrexial at 39 celsius, with cervical and occipital lymphadenopathy. He was neurologically intact. A CT head scan confirmed marked soft-tissue swelling of the scalp and face, with extensive sub-galeal air and foreign material. There was no skull fracture. (Fig. 1) At operation a thorough debridement was performed excising necrotic galea and periosteum to healthy margins. Post-operatively his chemotherapy included penicillin 2 g 4 hourly, gentamicin and metronidazole. Bacteriological culture indi-