3. Culture: Culture may be taken if the diagnosis is in question, when there is lack of response to standard therapy, or where circumstances suggest the possibility of an unusual organism. Culture of the nasopharynx may be helpful with facial involvement, and culture of intact vesicles or bullae will sometimes reveal the offending bacteria. Cultures of entry wounds are often misleading and help only if they correlate with other cultures. If the victim is septic, blood cultures are an excellent source. In a desperate situation, aspiration of involved skin after saline infiltration or culture of minced tissue from a carefully obtained punch biopsy may identify an organism, but the yield is low.
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