Background. Necrotizing soft tissue infections of the chest wall are u
ncommon, and they have received little discussion in the medical liter
ature. Methods. We performed a collective review of the literature to
summarize information on etiology, prevention, treatment, complication
s, and outcome of chest wall necrotizing soft tissue infections. Manua
l, Medline, and Current Contents searches of the English-language medi
cal literature were done. Results. There were 9 reported cases of necr
otizing soft tissue infection of the chest wall. Eight were complicati
ons of invasive procedures and operations. Tube thoracostomy for empye
ma (4 patients) was the most common antecedent procedure, Excessive so
ft tissue dissection during chest tube insertion was implicated in the
genesis of these infections. Necrotizing infections complicated esoph
ageal operations in 2 patients. Overall mortality was 89%. Only 3 of t
he 9 patients underwent early and adequate debridement. Chest wall sta
bility and wound reconstruction eye rf problematic in patients who sur
vived the initial septic illness. Conclusions. Necrotizing soft tissue
infections of the chest wall are highly lethal infections that requir
e urgent and aggressive debridement. Diagnostic delay and inadequate d
ebridement are common reasons for treatment failure. Repetitive surgic
al debridement is often needed to control sepsis. Wound closure is cha
llenging in patients who sun ive the initial septic phase of their ill
ness.