Extensive facial trauma caused by dog bites in woman suffering from systemic fluconazole-resistant Candida infection.
BACKGROUND
Dog bites present a complex problem. Extensive facial trauma is a challenging problem to treat with priority for functional outcome. This paper describes the conservative treatment in a very difficult case of facial trauma with unusual infections due to the bites.


METHODS
A 45 year-old woman was admitted in hypovolaemic shock with amputation of nose, upper and lower lips, left cheek and chin caused by dog bites. After vital parameters and volaemy were stabilized, wound toilet was performed, followed by skin and mucosal rotation flaps and anterior nasal tamponade; the lesion has then been covered with a collagen/oxidized regenerated cellulose dressing and sterile gauzes. Culture test highlighted coagulase-negative Staphylococcus and Candida albicans. However after few days, the patient developed septic-undulant hyperpyrexia, retinitis, renal candidiasis, folliculitis. Systemic Candida infection resistant to fluconazole was diagnosed. Amphotericin B was given to the patient and the facial wound was managed conservatively with an active medication because of inoperability conditions. The outcome of the use of active medications was an immediate response with excessive granulation tissue followed by a rapid re-epithelization.


CONCLUSIONS
As our case has shown, conservative treatment can be a valid alternative therapy in the treatment of large wounds with invasive candidosis and candidaemia or other major contraindications to surgery. In fact, in cases where surgical reconstruction is not a feasible option, conservative treatment can allow a rapid repair of the skin barrier.
Department of Plastic Surgery, Sapienza, University of Rome, Italy.
A M
AM
Spagnoli
G
G
Monacelli
M I
MI
Rizzo
N
N
Fallico
N
N
Scuderi
D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy; D047070:Bandages, Hydrocolloid; D001733:Bites and Stings / Q000150:complications*; D002176:Candida albicans / Q000187:drug effects; D058387:Candidemia / Q000150:complications* / Q000188:drug therapy; D002482:Cellulose / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D000075202:Contraindications; D003646:Debridement; D004285:Dogs; D025141:Drug Resistance, Fungal; D005151:Facial Injuries / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D014945:Wound Healing / Q000187:drug effects
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole; D002482:Cellulose; D003094:Collagen