title: Using free flaps for reconstruction during infections by mucormycosis: A case report and a structured review of the literature.
abstract: BACKGROUND
  Mucormycosis is a very rare infection caused by fungi from the order Mucorales, it rarely involves the skin. We report a case of necrotizing fasciitis of the upper limb which required an aggressive surgical debridement, antifungal therapy and coverage of the defect with a free DIEP flap, a review of the literature was also done regarding indications of reconstruction with free flaps.
  
  
  METHODS
  Here we present a case of cutaneous mucormycosis of the right upper limb in a 49-year-old immunocompetent woman after having an open fracture associated with massive contamination during a motor vehicle collision. In early postoperative period, she had multiple skin necrotic lesions. Serial surgical debridements were performed and ended up with interscapular-thoracic amputation associated with a total mastectomy. Following diagnosis confirmation of mucormycosis infection, the patient was started on antifungal therapy for several months. After disease control, the large defect was successfully covered by a DIEP flap.
  
  
  CONCLUSIONS
  Cutaneous mucormycosis requires antifungal therapy along with aggressive debridement, reconstruction by a free flap seems to be a good solution to cover these large defects.
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France. Electronic address: c.reinbold@hotmail.fr.
authors.forename: C
authors.initials: C
authors.lastname: Reinbold
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Derder
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Hivelin
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ozil
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Al Hindi
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D003881:Dermatomycoses / Q000209:etiology / Q000628:therapy*; D005260:Female; D005597:Fractures, Open / Q000150:complications; D058752:Free Tissue Flaps; D006801:Humans; D007121:Immunocompetence; D008875:Middle Aged; D009091:Mucormycosis / Q000209:etiology / Q000628:therapy*; D011885:Radius Fractures / Q000150:complications; D014458:Ulna Fractures / Q000150:complications
chemical_list: D000935:Antifungal Agents
keywords: DIEP; Free flap; Infection; Lambeau libre; Mucormycose; Mucormycosis; Reconstruction; Traumatisme du membre supérieur; Upper limb trauma