PubMed · 16565127
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Dean E Boyce, Kayvan Shokrollahi. 2006-03-25. Reconstructive surgery.. https://doi.org/10.1136/bmj.332.7543.710
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OBJECTIVE: The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections (>72 h) in extremely low birth weight (ELBW) infants. STUDY DESIGN: Retrospective analysis of a prospective cohort study of 201 ELBW infants who survived greater than 3 days after birth. Mean morning glucose levels were categorized as normoglycemia (<120 mg/dl), mild-moderate hyperglycemia (120 to 179 mg/dl) and severe hyperglycemia (> or =180 mg/dl). Hyperglycemia was further divided into early (first 3 days of age) and persistent (first week of age). Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection, measured after 3 and 7 days of age. RESULTS: Adjusting for age, the odds ratio (OR) for either dying or developing a late infection was 5.07 (95% confidence interval (CI): 1.06 to 24.3) for infants with early severe hyperglycemia and 6.26 (95% CI: 0.73 to 54.0) for infants with persistent severe hyperglycemia. Adjusting for age, both severe early and persistent hyperglycemia were associated with increased mortality. Among survivors, there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay. Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis, after adjusting for age and male gender (OR: 9.49, 95% CI: 1.52 to 59.3). CONCLUSION: Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants.
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Chest wall necrotizing fasciitis is a rare and often fatal infection that usually requires extensive debridements and reconstructive procedures. We describe the therapeutical course of an uncommon case of perforating thoracic wound complicated with necrotizing fasciitis, with consecutive debridements and a resultant full-thickness subscapular defect. We agree that free flaps, although seldom required, must be considered when treating more complex defects. Latissimus dorsi free-flap was enough for pleural reconstruction and wall stabilization. There are no previous references in the literature to primary chest wall fasciitis treated successfully with microsurgical reconstruction.