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Ann Thorac Surg 2002;73:1694-1695
© 2002 The Society of Thoracic Surgeons

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Correspondence

Necrotizing soft tissue infection of the chest wall

^a Department of Surgery, School of Medicine, University of Missouri-Columbia, M580 Health Sciences Center, One Hospital Dr, Columbia, MO 65212, USA

e-mail: jonesjw{at}health.missouri.edu

To the Editor

We read with interest the recent article by Safran and Sullivan on necrotizing fasciitis (NF) of the chest wall [1]. The article provides an excellent analysis of 12 patients affected by this unusual and life-threatening condition, but the accompanying literature review did not include three significant published reports of chest wall NF. These articles discuss spontaneous full-thickness necrosis of the sternum and adjacent costal cartilages in a previously healthy child [2], NF after reduction mammoplasty and mastectomy for carcinoma [3], and the only reported case of chest wall NF after cardiac surgery [4]. Safran and Sullivan write that 77% of all necrotizing soft tissue infections are monomicrobial and present in a fulminant fashion [1]. Among the 17 patients reported in the world literature, 6 (35%) had mono- and 10 (59%) polymicrobial infection. No microorganisms were cultured from the wounds of 1 recent survivor [4]. It appears that factors other than bacteriology can account for the extremely high fatality rate in chest wall NF. Most of the patients reported to have died with the condition had chronic predisposing conditions, and more than 80% experienced significant diagnostic delays before treatment was initiated [2–4].

Safran and Sullivan’s study is nevertheless important because it stresses the need for early recognition, aggressive surgical deridement, appropriate antibiotic therapy, and intensive care, mainstays of successful chest wall NF management. Their clinical success characterizes assiduous application of these principles.

References

1. Safran D.B., Sullivan W.G. Necrotizing fasciitis of the chest wall. Ann Thorac Surg 2001;72:1362-1364.[Abstract/Free Full Text]
2. Dayal A., Gupta L.P., Patawari J., Dave K.S. The chest wall gangrene in an infant. Indian J Chest Dis Allied Sci 1979;21:102-104.[Medline]
3. Eugster T., Aeberhard P., Reist K., Sakmann K. Streptococcal necrotizing fasciitis with fatal outcome—a case report. Swiss Surg 1997;3:117-120.[Medline]
4. Frota Filho J.D., Drews C., Leaes P., et al. Postoperative necrotizing fasciitis of the thorax in cardiac surgery. Arq Bras Cardiol 2001;76:250-254.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James W. Jones Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Losanoff, J. E. Articles by Jones, J. W. Search for Related Content PubMed Articles by Losanoff, J. E. Articles by Jones, J. W. Related Collections Chest wall