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Erschienen in:
12.12.2019 | Original Paper
Cranio-facial mucormycosis—the plastic surgeon’s perspective
Erschienen in: European Journal of Plastic Surgery | Ausgabe 3/2020
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Background
Facial mucormycosis is a rare disease entity with high mortality and morbidity. Recently, extensive facial mucormycosis has been treated by plastic surgeons due to the complexity of structures involved and the need for reconstruction once the patient is free from disease. There is still confusion regarding the disease’s diagnosis, treatment guidelines, confirmation of disease-free status, and planning of reconstruction.
Methods
This is a case series on facial mucormycosis. We discuss our clinical experience with main focus on current treatment strategies including guidelines for reconstructive surgery.
Results
We included five patients in the study. The injuries were secondary to minor trauma. All of them had diabetes. We established the diagnosis by histopathology. One patient died. The rest of the four patients were managed with surgical debridement and IV liposomal amphotericin B. Defects were managed primarily with autologous flaps; the prosthesis was added to improve the cosmetic outcome.
Conclusions
We should maintain a high index of suspicion in cases of necrotizing facial infections. Tissue biopsy will confirm the diagnosis of mucormycosis. A multidisciplinary approach should be applied. The main principles of management would include reversal of immunosuppression or any metabolic disorder, systemic and local antifungal medication, prompt surgical excision of the infected tissues with early aggressive supportive measures, and appropriate reconstruction with rehabilitation. Both prosthetic-based and autologous reconstructions of the resultant defects have been proposed. Choosing either option depends on the surgeon’s expertise. Prosthesis-based reconstruction provides a relatively accurate esthetic result. As in micro vascular techniques advance and patient demands for a permanent reconstruction increase, more surgeons are trending towards autologous tissue transfer.
Level of evidence: Level IV, therapeutic study