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.