Reconstructive Surgery for Mycetoma: Is There a Need to Establish an Algorithm?

Abstract

Background: Mycetoma is a chronic, progressive, disfiguring, and destructive disease. It caused by a variety of microorganisms including fungi and higher bacteria. It is primarily an infection of the skin and soft tissue, most frequently affecting the lower extremity and the hand and spread through fascial planes and lymphatics. Methods: Current medical and surgical management are still inadequate and the recurrence rate is high with severe disabilities. Results: This review describes some reconstructive techniques that were performed to address essential aspects with regard to mycetoma surgical management that include coverage of large skin and soft-tissue defects left after local excisions, enhancing the rate of chronic mycetoma wound healing, and preservation or restoration of functional status of the affected limbs. Conclusion: These applied techniques—which had acceptable preliminary outcome—have to be considered by the surgeons dealing with mycetoma to improve the functional and cosmetic outcomes and to minimize tremendous morbidities and disabilities that are associated with this neglected disease.

Reconstructive Surgery for the Neglected Tropical Diseases: Global Gaps and Future Directions

“…15 Drug management may be required for up to 12 months after surgery, which is costly, and surveillance is required for 2 years to ensure a definitive cure. 12 Many of the surgical methods used are focused on improving immediate outcomes. Initial surgical management involves establishing local control with the addition…”

“…18 Even with aggressive surgical control, the recurrence rate may be as high as 50%. 12 Once local control has been established, reconstructive surgery may be required to close larger legions. 11 In the setting of limited resources in low-and middleincome countries, the simplest techniques along the reconstructive ladder such as split-thickness skin grafts, local tissue rearrangement with random pattern flaps, and local pedicled flaps (musculocutaneous or muscle flaps), are preferred (Fig.…”

“… 11 The disease results in these granulomatous open wounds that are often complicated by superimposed bacterial infections, which can require debridement and drug administration to control and prevent ongoing infection or progression to sepsis. 9 , 12 , 13 Depending on if the mycetoma is caused by actinomycetoma (bacteria) or eumycetoma (fungus), patients will either use cotrimoxazole or itraconazole, respectively, after surgical debulking. 14 However, these treatments are costly and require patients’ adherence for an extensive period of time.…”

Eumycetomas by Fusarium oxysporum and Madurella mycetomatis. Description of two cases and literature review

“…En relación al estudio radiológico de este tipo de lesiones diversos autores [ 8 - 11 ] subrayan la importancia de la resonancia magnética para visualizar la afectación de tejidos blandos y destrucción ósea asociados a micetoma. En la RM se aprecian múltiples pequeñas lesiones hiperintensas esféricas separadas por tejidos de baja intensidad de señal.…”

“…La mayoría de los estudios publicados [ 6 , 8 , 12 , 13 ] indican, en relación al abordaje terapéutico de estas lesiones, la necesidad de una combinación médica (antifúngico) y quirúrgica (exéresis de la lesión) para lograr el éxito en el tratamiento del eumicetoma,…”