Abstract
Background Excessive use of corticosteroids therapy along with gross immunocompromised conditions
in the novel coronavirus disease 2019 (COVID-19) pandemic has raised the risks of
contracting opportunistic fungal infections. Here, we describe our experience with
the implementation of a surgical protocol to treat and reconstruct rhino-orbital-cerebral
mucormycosis.
Methods A retrospective review of our prospectively maintained database was conducted on
consecutive patients diagnosed with mucormycosis undergoing immediate reconstruction
utilizing our “Mucormycosis Management Protocol.” All patients included in this study
underwent reconstruction after recovering from COVID-19. Wide local excision was performed
in all cases removing all suspected and edematous tissue. Reconstruction was done
primarily after clear margins were achieved on clinical assessment under a cover of
injectable liposomal amphotericin B.
Results Fourteen patients were included. The average age was 43.6 years and follow-up was
24.3 days. Thirteen patients had been admitted for inpatient care of COVID-19. Steroid
therapy was implemented for 2 weeks in 11 patients and for 3 weeks in 3 patients.
Eight patients (57.1%) had a maxillectomy and mucosal lining resection with/without
skin excision, and six patients (42.8%) underwent maxillectomy and wide tissue excision
(maxillectomy and partial zygomatic resection, orbital exenteration, orbital floor
resection, nose debridement, or skull base debridement). Anterolateral thigh (ALT)
flaps were used to cover defects in all patients. All flaps survived. No major or
minor complications occurred. No recurrence of mucormycosis was noted.
Conclusion The approach presented in this study indicates that immediate reconstruction is safe
and reliable in cases when appropriate tissue resection is accomplished. Further studies
are required to verify the external validity of these findings.
Keywords
COVID-19 - free tissue flaps - mucormycosis - antifungal agents - reconstructive surgical
procedures
