Introduction
Necrotizing soft tissue infections (NSTIs) are life-threatening
conditions firstly described by Wilson in 1952. He portrayed a rare
infection characterized by bacteria-induced necrosis of the subcutaneous
tissue and fascia [1] with mortality from 6% to 80% [2] . The
infection travels along planes and later can potentially involve deeper
muscles with resultant myositis and myonecrosis.
The etiology is based on mono or polymicrobial infection and most
frequently arises from odontogenic infections [3]. Nowadays the
management is based on a rapid and aggressive surgical treatment with
removal of the necrotic tissue along with broad spectrum antibiotic
therapy. Some facilities have also included hyperbaric oxygen therapy
(HBOT) [4]. The Italian Society of Undersea and Hyperbaric Medicine
(SIMSI) is withheld the Italian authority on the indications for HBOT.
In the 2nd edition of their guidelines HBOT was also recommended as
adjuvant therapy in NSTIs [5]. Despite this, HBOT is not usually
used as a standard of care in these patients and this happens for
several reasons: not all hospitals are equipped with a hyperbaric
medicine service, a high percentage of doctors do not know the
usefulness of HBOT and its possible use in these conditions and
well-controlled, randomized, clinical trials demonstrating a
statistically significant benefit of HBOT are lacking and consequently
its use as an adjunctive therapy for NSTIs remains controversial[6].
Besides transfer to a hospital equipped with HBOT, we should never delay
emergency surgical intervention.
We report the case of a young patient affected by NSTI resulting from
dental infection and complicated by necrotizing myositis of right
pectoral muscle treated with standard of care plus HBOT as adjuvant
therapy.