Surgical management of congenital tracheal stenosis.

Congenital tracheal stenosis is a rare and potentially lethal malformation. Although congenital tracheal stenosis carries a high mortality rate, advances in surgical treatment have increased the likelihood of survival, and these patients are seen with increasing frequency in intensive care units. The surgical options available are dilation, resection, and tracheoplasty. Because of the lack of a prosthetic replacement, resection is generally limited to lesions involving less then one third of the trachea. Tracheoplasty with a variety of graft materials has, in some cases, been successful in increasing the diameter of the stenotic trachea. Postoperative care involves maintaining paralysis and sedation until healing is established, with close attention to preventing complications. The needs of the family are addressed through teaching and support. A case of successful tracheal reconstruction, by use of an autologous cartilage graft, in a 14-day-old infant with severe stenosis from just below the vocal cords extending to the hilum is presented.

Necrotizing fasciitis.

Necrotizing fasciitis has long been recognized as an acute life-threatening infection requiring aggressive treatment. It generally occurs after minor trauma, but often there is no history of injury. The skin in necrotizing fasciitis is pale or red with no clear line of demarcation between affected and normal skin. There is extensive undermining of the skin with a foul-smelling sanguineous exudate. The superficial fascia and the deep fascia can be easily separated and will appear stringy, ragged, and dull gray to gray-green in color. Muscle, bone, or viseral involvement is not a feature of necrotizing fasciitis. The systemic response is one of an acutely ill patient with prostration and clouding of sensorium. Anemia, low serum calcium level, and fluid volume deficits are commonly seen along with other nonspecific laboratory and clinical findings common to serious acute infections. Necrotizing fasciitis is a polymicrobial disorder and not a specific bacterial infection. Beta-hemolytic streptococci, Staphylococcus aureus, and mixed gram-negative organisms are most frequently reported as etiologic agents, with more recent reports usually demonstrating a combination of anaerobic and facultative anaerobic bacteria. The primary therapy consists of radical surgical debridement of all nonviable tissue with frequent postoperative checks to monitor for further dissection that would require additional surfical debridement. Local wound care consists of diligent cleaning and application of loose gauze soaked with a topical agent. Parenteral antibiotic therapy based upon the Gram stain and further modified on the basis of bacterial culture and sensitivity studies, is started immediately. Management also involves correction of fluid and electrolyte imbalances, correction of anemia, and general supportive care.(ABSTRACT TRUNCATED AT 250 WORDS)