Document Detail


Acute wound closure and reconstruction following head zygomycosis: presentation of two cases and review of literature.
MedLine Citation:
PMID:  18798145     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Zygomycosis is a rare but very aggressive fungal infection mainly seen in immunocompromised patients. Immediate diagnosis and treatment with antifungal therapy, control of underlying disease, and early surgical debridement is essential. We present two cases of head zygomycosis treated with systemic liposomal amphotericin B, surgical debridement, and immediate free flap reconstruction. A retrospective chart review of two cases of zygomycosis was performed; one with rhino-sino-orbital-cerebral and the other with scalp/cranial zygomycosis. Both patients were treated with systemic liposomal amphotericin B, aggressive debridement, and immediate reconstruction following local control. The multidisciplinary team approach and the surgical technique are discussed. Patient 1 (with rhino-sino-orbital-cerebral zygomycosis) died 2 weeks after diagnosis, and patient 2 (with scalp/cranial zygomycosis) was disease free at 1-year follow-up. Both patients' flaps survived, although patient 2 needed to undergo an arterial revision with an interpositional vein graft within 24 hours of surgery. We concluded that to treat zygomycosis effectively, a multidisciplinary team approach is needed, focusing on immediate diagnosis, empirical antifungal therapy, reversal of underlying predisposing factors, and early surgical debridement. When definitive debridement results in critical structures being exposed, then early wound closure with healthy vascularized tissue is indicated. In these two patients with exposed dura after definitive debridement, immediate closure was performed to minimize the risk of meningeal and cerebral infections.
Authors:
Neta Adler; Iris A Seitz; Lawrence J Gottlieb
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-09-16
Journal Detail:
Title:  Journal of reconstructive microsurgery     Volume:  24     ISSN:  0743-684X     ISO Abbreviation:  J Reconstr Microsurg     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-21     Completed Date:  2009-01-27     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  8502670     Medline TA:  J Reconstr Microsurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  507-13     Citation Subset:  IM    
Affiliation:
Section of Plastic and Reconstructive Surgery, University of Chicago, Chicago, Illinois 60637, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antifungal Agents / therapeutic use
Bone Diseases, Infectious / drug therapy,  surgery
Central Nervous System Fungal Infections / diagnosis,  drug therapy,  surgery
Debridement
Dermatomycoses / drug therapy,  surgery
Head / surgery*
Humans
Male
Middle Aged
Nose Diseases / surgery
Orbital Diseases / surgery
Paranasal Sinus Diseases / surgery
Reconstructive Surgical Procedures / methods*
Scalp
Surgical Flaps
Zygomycosis / diagnosis,  drug therapy,  pathology,  surgery*
Chemical
Reg. No./Substance:
0/Antifungal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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