title: Successful knee extensor mechanism reconstruction in a warfare-related open lower extremity injury complicated by mucormycosis infection: a case report.
abstract: Subcutaneous zygomycosis infection associated with a lower extremity open fracture is a potentially life- and limb-threatening condition. This rare and poorly characterized infection complicating war wounds is unique, complex, and poses a significant reconstructive challenge. The objective of this article is to report the reconstruction of a complex Gustilo IIIC warfare-related distal femur fracture with partial extensor mechanism loss complicated by a subcutaneous zygomycosis infection using a novel combination of local and systemic antifungals with negative pressure wound therapy. Negative pressure wound therapy with silver-impregnated sponges and antibiotic/antifungal beads was used to provide temporary wound coverage, improve revascularization, and deliver local antifungal therapy. The distal open femur fracture was fixed using a lateral approach and the medial distal thigh wound and extensor mechanism were reconstructed using an extended gastrocnemius flap with skin graft. The limb was successfully salvaged and the patient is now ambulatory.
authors: Department of Plastic and Reconstructive Surgery, National Naval Medical Center, Bethesda, MD, USA. arkumar@mac.com
authors: Anand R
authors: AR
authors: Kumar
authors: Pasha
authors: P
authors: Hunt
authors: E Matthewe
authors: EM
authors: Ritter
authors: Robert
authors: R
authors: Howard
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D001753:Blast Injuries / Q000150:complications / Q000601:surgery*; D005264:Femoral Fractures / Q000150:complications / Q000628:therapy*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000150:complications / Q000628:therapy*; D006801:Humans; D007869:Leg Injuries / Q000150:complications / Q000601:surgery; D008297:Male; D009091:Mucormycosis / Q000150:complications / Q000628:therapy*; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D014857:Warfare
chemical_list: D000935:Antifungal Agents