Primitive necrotizing fasciitis of the thoracic wall: Fatal complication of diabetic patient

Abstract

Introduction: necrotizing fasciitis of the chest wall is a rare condition in subcutaneous tissues and deep fascia. Primary thoracic involvement is exceptional and is a diagnostic and therapeutic emergency.
Aim: To report our experience in the management of this rare pathology of which clinical picture is unknown by most practitioners.
Methods: This is a retrospective study carried out over a period of 07 years, compiling 07 cases of primitive necrotizing fasciitis of the thoracic wall at the department of thoracic surgery at the CHU Hassan II in Fez.
Results: Patients were five men and two women, with an average age of 58 years. All our patients were known to have poorly balanced diabetes. The reason for consultation was a swelling of the chest wall with fever in all patients. On the results of thoracic computed tomography (CT), the presence of a deep collection of soft tissue was found   in all patients. The treatment was a large necrosectomy, taking away the skin as well as the adjacent muscle. Postoperative follow-up was favorable in five patients. We noted two deceased patients due to postoperaive septic shock. Conclusion: Necrotizing chest wall fasciitis is a medical and surgical emergency, requiring early diagnosis and rapid and appropriate management which will determine the prognosis.