NECROTIZING SOFT-TISSUE INFECTIONS OF THE CHEST-WALL

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.