title: Necrotizing soft tissue infections of the chest wall.
abstract: BACKGROUND
  Necrotizing soft tissue infections of the chest wall are uncommon, and they have received little discussion in the medical literature.
  
  
  METHODS
  We performed a collective review of the literature to summarize information on etiology, prevention, treatment, complications, and outcome of chest wall necrotizing soft tissue infections. Manual, Medline, and Current Contents searches of the English-language medical literature were done.
  
  
  RESULTS
  There were 9 reported cases of necrotizing soft tissue infection of the chest wall. Eight were complications of invasive procedures and operations. Tube thoracostomy for empyema (4 patients) was the most common antecedent procedure. Excessive soft tissue dissection during chest tube insertion was implicated in the genesis of these infections. Necrotizing infections complicated esophageal operations in 2 patients. Overall mortality was 89%. Only 3 of the 9 patients underwent early and adequate debridement. Chest wall stability and wound reconstruction were problematic in patients who survived the initial septic illness.
  
  
  CONCLUSIONS
  Necrotizing soft tissue infections of the chest wall are highly lethal infections that require urgent and aggressive debridement. Diagnostic delay and inadequate debridement are common reasons for treatment failure. Repetitive surgical debridement is often needed to control sepsis. Wound closure is challenging in patients who survive the initial septic phase of their illness.
authors.affiliation: Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Urschel
authors.forename: H
authors.initials: H
authors.lastname: Takita
authors.forename: J G
authors.initials: JG
authors.lastname: Antkowiak
mesh_terms: D003646:Debridement; D006801:Humans; D018482:Muscle, Skeletal / Q000473:pathology; D009135:Muscular Diseases / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D018461:Soft Tissue Infections / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013909:Thorax