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.

Early Complications and Outcomes in Combat Injury–Related Invasive Fungal Wound Infections

“…1–3,5–10 Among wounded military personnel, the impact of trauma-related IFI complications became increasingly relevant as advances in combat care during recent wars in Iraq and Afghanistan improved the survivability of severe trauma, including blast-related traumatic amputations. 11,12 In general, trauma-related IFIs develop following a penetrating injury contaminated with environmental debris containing molds in susceptible patients.…”

Cutaneous mucormycosis secondary to penetrative trauma

“…Recent genome sequencing of mucormycosis and ex-vivo confocal microscopy offer formidable solutions in the reduction of time to diagnosis and hastening treatment [31]. Topical delivery of anti-fungals offer a significant advantage given that systemic bioavailability of pharmacotherapy A c c e p t e d M a n u s c r i p t is impaired in Mucormycosis.…”

Therapeutic Effects of Slotted Manuduction on Knee Extension Apparatus-induced Traumatic Adhesion

“…Manipulative steps and methods in the control group: 1) posture: the patient lay in supine position, and the doctor stood on the side of affected knee; 2) massage from quadriceps femoris to tibial tubercle with both hands, massage quadriceps femoris group by relaxing practices, and push patella left and right, up and down 10 times respectively; then, do the moving-aside test, drawer test and Mcmurray's test on the affected knee 3 times respectively; 3) raise the straight leg of patient by 45°, support the distal thigh with one hand to make shanks hang down naturally, slightly put pressure with the other hand; then complete flexion of the hip joint was made, the doctor put one hand on the knee, and the other hand held the ankle to put pressure for flexion; strengthen flexion training when extensor muscles were in a relaxing state. This manuduction was repeated 8 to 10 times; 4) the patient was in a prostrate position, support pads put in the lower abdomen and before hip; the doctor pressed the distal thigh with one hand, the other hand held the ankle to put pressure for flexion to gradually transit to a genuflex sitting state to close to the knee-chest prone position This manuduction was repeated 8 to 10 times; 5) end manuduction: relax for 5min by patting, striking, smoothing and straightening quadriceps femoris and peripatellar soft tissue [10].…”