REVIEW ARTICLES  THORACIC SECTION 

The Journal of Cardiovascular Surgery 2002 August;43(4):549-52

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Necrotizing soft tissue infection of the chest wall

Losanoff J. E., Richman B. W., Jones J. W.

Department of Surgery Health Sciences Center University of Missouri-Columbia School of Medicine Columbia, MO, USA

Necro­tizing ­soft ­tissue infec­tion (­NSTI) of the ­chest ­wall is a rel­a­tively ­rare but ­highly ­lethal sur­gical infec­tion ­which has ­received ­little atten­tion in the med­ical and sur­gical lit­er­a­ture. The ­data ­reported are ­based on a lit­er­a­ture ­review, ­including a Med­line data­base ­search, and ­search of ­existing bib­liog­ra­phies. ­Twenty ­well-doc­u­mented ­cases of pri­mary ­chest ­wall involve­ment by ­NSTI ­were ­found. Thir­teen ­patients ­were ­male. ­Patients’ ­ages ­ranged ­from 10 ­weeks to 78 ­years. Thir­teen ­patients ­were post­op­er­a­tive (65%). The diag­nosis was ­initially con­sid­ered in ­only 3 of the post­op­er­a­tive ­cases, a ­cause of sig­nif­i­cant ­delays in sur­gical treat­ment. ­Among ­those who ­lived ­long ­enough for ­their ­wounds to ­close, 2 had sec­on­dary ­healing, 5 expe­ri­enced ­delayed ­skin ­grafting ­over the gran­u­lating ­wound, and 1 had ­skin ­grafting com­bined ­with ­muscle ­transfer. Mor­tality was 60%. ­Chest ­wall ­NSTI is a rap­idly ­spreading, ­highly ­lethal infec­tion. A ­high ­index of sus­pi­cion, ­early diag­nosis, and aggres­sive ­approach are essen­tial to its suc­cessful treat­ment.