Management of necrotizing XXXX .

@entity1 @entity16 @entity281 @entity5154 @entity4005
Management of three @entity1 with necrotizing @entity281 resulting in tracheal dissolution was reviewed with respect to presentation, cause, and management. Loss of tracheal substance led to difficulty in ventilation because of a large air leak. The stomal area cavitated in two @entity1 , denuding the right common carotid artery in one. Purulent peristomal drainage was present in all three @entity1 . Common factors of possible etiologic significance included necrotizing polymicrobial gram-negative @entity281 caused by Pseudomonas, Enterobacter, and @entity4005 species. Also of possible importance were suture fixation of the appliance, history of @entity16 , and closure of the incision. Immediate therapy consisted of oral intubation for ventilatory purposes and a regimen of hourly application of 1% @entity5154 dressings. Seven to 21 days were necessary to allow formation of sufficient granulation tissue to support replacement of the tracheostomy appliance for continued mechanical ventilation. Once spontaneous ventilation was possible, a Montgomery T-tube was inserted for long-term tracheal stenting prior to reconstruction. The two @entity1 treated by tracheal stenting are long-term survivors. Avoidance of suture fixation of the appliance, aggressive treatment of @entity281 , and adequate stomal toilet may help to avoid this devastating complication.
