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Ann Thorac Surg 1985;40:396-397
© 1985 The Society of Thoracic Surgeons

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Articles

Clostridial Myonecrosis of the Chest Wall Complicating Spontaneous Esophageal Rupture

From the Division of Cardiothoracic Surgery, Northwestern University Medical School, Chicago, IL.

Accepted for publication December 7, 1984.

^* Address reprint requests to Dr. LoCicero, Northwestern University Medical School, 303 E Chicago Ave, Ward Bldg 9–105, Chicago, IL 60611

Spontaneous rupture of the esophagus (Boerhaave's syndrome) has a dismal survival rate without prompt surgical management. A variety of surgical regimens have achieved survival of 70% or greater; however, the postoperative course is frequently complicated by fistula, would infection, empyema, and sepsis. We report an unusual postoperative chest wound infection of clostridial myonecrosis, which presumably originated from the patient's gastric microflora. He was treated with immediate surgical debridement of all involved tissue, prolonged ventilation, total parenteral nutrition, and frequent dressing changes. The remaining defect was closed with a skin graft. Anaerobic wound infections of the chest wall and their management are discussed.

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