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

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.

Post-COVID-19 Rhino-Orbito-Maxillary Mucormycosis Defect: Our Surgical Experience with Single Stage Delayed Reconstruction Using Free Flap

“…The majority of the cases of post- COVID-19-associated ROM defect reported in the literature have been rehabilitated prosthetically using intraoral obturators, partial dentures, palatal flaps, and other soft-tissue flaps. 5 17 A recent study by Gupta et al 18 used ALT flaps for covering COVID-19-associated mucormycosis defects in 14 patients. All flaps in their study survived, without any major or minor complications.…”

Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure

“…Using a second free flap to salvage a reconstruction that has previously experienced flap loss is technically demanding because the most suitable reconstructive option has already been used and the surgical field is often contaminated. 6 Because of the morphology and function of the head and neck, important structures such as main vessels and the central nervous system require expeditious coverage 20 ; and adjuvant radiotherapy and chemotherapy, saliva, and infection can severely affect the wound bed for tissue transfer. 6,21 Moreover, the nutritional status of patients and multiple comorbidities can also compromise the recipient site, 6 ultimately affecting the normal progression of wound healing.…”

Advances in Translational 3D Printing for Cartilage, Bone, and Osteochondral Tissue Engineering

“…[ 143,144 ] In addition, 3D printed implants were also demonstrated to reconstruct acetabular defects, mandibular defects, large metaphyseal segmental femoral bone defects, calcaneal fractures and to treat terminal stage osteoarthritis. [ 145–148 ] We further searched “3D printing,” “bone,” “cartilage,” and “osteochondral” as the keywords to look into the clinical trials registered at both Clinical Trail.gov and Chinese Clinical Trial Registry (ChiCTR) ( Table 1 ). A total of 34 clinical trials have been registered with a projected enrollment of over 1400 patients, exhibiting the rapid growth of this field.…”