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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 397-404
DOI: 10.1055/s-0042-1748654
Pediatric/Craniomaxillofacial/Head & Neck
Original Article

Mucormycosis Management in COVID-19 Era: Is Immediate Surgical Debridement and Reconstruction the Answer?

Samarth Gupta
1   Department of Plastic, Reconstructive and Burns Surgery, Sawai Man Singh Hospital, Jaipur, Rajasthan, India
,
Pradeep Goil
1   Department of Plastic, Reconstructive and Burns Surgery, Sawai Man Singh Hospital, Jaipur, Rajasthan, India
,
Arbab Mohammad
3   Aarupadai Veedu Medical College and Hospital, Puducherry, India
,
Joseph M. Escandón
4   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
› Author Affiliations Funding None.
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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

Author Contributions

Conceptualization: all authors. Data curation: all authors. Formal analysis: all authors. Funding acquisition: P.G. and S.G. Investigation: all authors. Methodology: all authors. Project administration: all authors. Resources: all authors. Software: all authors. Supervision: P.G. and S.G. Validation: all authors. Visualization: all authors. Writing-original draft: all authors. Writing-review and editing: all authors.


Patient Consent

Informed consent was obtained from all individual participants included in the study.


Supplementary Material



Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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