Facial reconstruction after mucormycosis in an immunocompetent host.
Cutaneous mucormycosis in the immunocompetent patient is exceedingly rare. However, if the infection is not rapidly identified and aggressively treated, its progression is fast, fulminate, and characteristically fatal. This case report describes the treatment and surgical reconstruction of a previously healthy, immunocompetent girl after pervasive mucormycosis of the right face. The patient's diagnosis was established by tissue biopsy. She was promptly started on 1.5 mg/kg per day intravenous amphotericin B and underwent numerous surgical debridements resulting in a large defect of the right face. After 2 xenograft procedures the defect was covered with an autologous split thickness skin graft. During this procedure a submandibular 4 x 7-cm tissue expander with a remote occipital port was placed superficial to the platysma. Serial tissue expansion took place over 8 weeks without complication. The tissue expander was removed and the expanded flap was advanced over the freshly de-epithelialized defect. Revisional surgeries may yet be performed; notwithstanding, the patient and her parents are pleased with the current results. Although the management of cutaneous mucormycosis often involves disfiguring tissue resection, the current wealth of reconstructive modalities can greatly improve the aesthetic and functional outcomes of requisite therapy.
Tidwell
James
J
Division of Plastic and Reconstructive Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Higuera
Stephen
S
Hollier
Larry H
LH
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002610:Cheek / Q000382:microbiology / Q000601:surgery*; D003646:Debridement; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007121:Immunocompetence; D007223:Infant; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000379:methods*
D000935:Antifungal Agents; D000666:Amphotericin B