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

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Correspondence

Necrotizing soft tissue infection of the chest wall: reply

^a Trauma Service and CMA General Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA

To the Editor

We thank Dr Losanoff and colleagues for their kind response to our case report. As stated in the discussion section of the article, our literature review is restricted to more recent reports than that described by Dayal and coworkers in 1979, and publication of our case report apparently preceded MedLine cataloging of Frota and associates’ report in 2001. We recognize that the manuscript by Eugster and coworkers was not retrieved during our own search, and we appreciate the recognition by Losanoff and colleagues of this case report.

We also appreciate the correction made by the authors regarding the distribution of monomicrobial versus polymicrobial etiologies for necrotizing soft tissue infection. In our discussion, the statistics (77% polymicrobial, 23% monomicrobial) were inadvertently inverted. We apologize for the error. We also agree with the authors of this letter that factors other than bacteriology may account for the outcome in any patient suffering from these severe infections. They tend to occur predominantly in debilitated patients with significant preexisting comorbidities, particularly diabetes mellitis. Such comorbidities often impede the required cardiopulmonary response to a septic insult that may often be a prerequisite for survival.

As emphasized in our report and echoed by the authors of this letter, early recognition, source removal, and treatment of residual circulating bacteremia, with aggressive supportive care for the septic response, are, at present, the only hopes of survival. Interestingly, with new medical therapies becoming imminently available for treatment of the septic response [1], overall survival from this lethal condition may be improved in the future.

References

1. Bernard G.R., Vincent J.-L., Laterre P.-F., et al. N Engl J Med 2001;344:699-709.

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Safran, D. B. Articles by Sullivan, W. G. Search for Related Content PubMed PubMed Citation Articles by Safran, D. B. Articles by Sullivan, W. G. Related Collections Cardiac - physiology Chest wall Related Articles