PMC3135043_01
Time course of anterior tracheal necrosis under treatment.
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Prompt surgical exploration of the neck revealed a necrotic anterior part of the trachea involving the second to the fifth tracheal rings and a perforation of the third and fourth rings (Figure 1(a)). The necrotic trachea was excised, leaving a large anterior defect that spanned 4 rings (Figure 1(b)). A separate small piece of foam was place in the defect to keep a hole to be refashioned into a formal tracheostomy allowing the later insertion of a tracheotomy canula (Figures 1(d) and 2(a)). Each time, the dressing was changed at bedside and the wound was debrided to decrease the amount of fibrotic and nonviable tissue (Figure 1(c)). The surrounding tissue was cleaned and completely dry until granulation tissue partially covered tracheal structures (Figure 1(d)).
Vacuum-assisted closure therapy.
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fig2
At the time of the first aggressive tracheal and cervical wound debridement, a vacuum-assisted closure device (VAC therapy) was used to manage the wound (Figure 2). A polyurethane sponge cell foam dressing ((VAC GranuFoam), recommended for stimulating granulation tissue and wound contraction, was cut to be slightly smaller than the wound (Figure 2(a)), placed directly onto the wound (Figure 2(b)), and loosely covered with a clear occlusive drape to encompass the entire wound (Figure 2(c)). The suction tubing was placed into the sponge at the end of the application of the dressing (Figure 2(c)) and covered with an additional piece of OpSite (Smith & Nephew), making sure to pinch the drape around the tubing to create a complete seal (Figure 2(d)).