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Erschienen in: European Journal of Plastic Surgery 1/2019

07.09.2018 | Review

Mycobacterium Ulcerans soft tissue defects: reconstructive challenges

verfasst von: Rachael Leung, Daniel Reilly, George Miller, Marc A. Seifman, David J. Hunter-Smith, Warren M. Rozen

Erschienen in: European Journal of Plastic Surgery | Ausgabe 1/2019

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Abstract

Background

Mycobacterium ulcerans (M. ulcerans) infection is a growing concern in Australia, with several disease hotspots in south-eastern Victoria (Guest 2016). Cases at our institution, located within one such endemic area, increasingly require reconstruction of substantial mycobacterial soft tissue deficits. This article comprises a focused literature review of flap reconstruction outcomes in significant M. ulcerans defects and the impact of antibiotic choice, duration of antimycobacterial therapy and time to reconstruction in this context, as well as a short case series.

Methods

A keyword search of Medline, Google Scholar and PubMed was conducted. In addition, four M. ulcerans flap reconstructions performed at our institution had case notes retrospectively reviewed for reconstruction indication, complications, outcomes and antibiotic therapy.

Results

Sixteen articles met inclusion criteria, of which 11 referenced flap reconstruction of M. ulcerans soft tissue defects in some manner. Antibiotic regimens, peri-operative details and flap outcomes were either only briefly mentioned or not at all and were not the focus of any of the articles. We present four cases of dorsal hand M. ulcerans defect, which were reconstructed with fasciocutaneous anterolateral thigh flaps due to extensive soft tissue loss with extensor tendon exposure. Antibiotic regimens varied. Each procedure was undertaken with minimal complication and excellent functional outcomes.

Conclusions

This review has identified the necessity of defining optimal reconstructive pathways in M. ulcerans soft tissue defects. Our cases demonstrate the successful use of fasciocutaneous flaps in refractory cases needing complex reconstruction. This paper presents the first review and case series on microvascular flap reconstruction of M. ulcerans defects. Level of Evidence Level IV, therapeutic study.
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Metadaten
Titel
Mycobacterium Ulcerans soft tissue defects: reconstructive challenges
verfasst von
Rachael Leung
Daniel Reilly
George Miller
Marc A. Seifman
David J. Hunter-Smith
Warren M. Rozen
Publikationsdatum
07.09.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Plastic Surgery / Ausgabe 1/2019
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-018-1459-3

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