Surgical management of rhinocerebral mucormycosis: A case series
Rhinocerebral mucormycosis (RCM) is a rare and rapidly progressive, destructive, angioinvasive fungal infection, which primarily affects immunocompromised patients. A high suspicion is required to diagnose RCM as initial clinical manifestations are often nonspecific. A cornerstone of the management...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | JPRAS Open |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352587821000607 |
| _version_ | 1819289754594705408 |
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| author | Mette Stueland Wolthers, MD, PhD Grethe Schmidt, MD Caroline Asirvatham Gjørup, MD, PhD Jannik Helweg-Larsen, MD, DMSc Niclas Rubek, MD Lisa Toft Jensen, MD |
| author_facet | Mette Stueland Wolthers, MD, PhD Grethe Schmidt, MD Caroline Asirvatham Gjørup, MD, PhD Jannik Helweg-Larsen, MD, DMSc Niclas Rubek, MD Lisa Toft Jensen, MD |
| author_sort | Mette Stueland Wolthers, MD, PhD |
| collection | DOAJ |
| description | Rhinocerebral mucormycosis (RCM) is a rare and rapidly progressive, destructive, angioinvasive fungal infection, which primarily affects immunocompromised patients. A high suspicion is required to diagnose RCM as initial clinical manifestations are often nonspecific. A cornerstone of the management is early diagnosis and radical surgery, which often requires complex reconstructive procedures.The optimal timing of reconstructive surgery is controversial.This case series presents the reconstructive perspective on four RCM cases treated with aggressive debridement, targeted antifungal treatment, and hyperbaric oxygen therapy followed by an early local flap or microsurgical reconstruction – to enable adequate local blood perfusion, antifungal treatment, and to decrease the risk of secondary infection. In all four patients, the early reconstructive surgery was successful without relapse of RCM or flap failure.We suggest aggressive surgical debridement till clear resection margins are obtained based on histopathology and/or microbiology, at a point which reconstructive surgery can be performed safely. |
| first_indexed | 2024-12-24T03:11:53Z |
| format | Article |
| id | doaj.art-589401b99bd34610a02a868bf9369ff7 |
| institution | Directory Open Access Journal |
| issn | 2352-5878 |
| language | English |
| last_indexed | 2024-12-24T03:11:53Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JPRAS Open |
| spelling | doaj.art-589401b99bd34610a02a868bf9369ff72022-12-21T17:17:48ZengElsevierJPRAS Open2352-58782021-12-01303337Surgical management of rhinocerebral mucormycosis: A case seriesMette Stueland Wolthers, MD, PhD0Grethe Schmidt, MD1Caroline Asirvatham Gjørup, MD, PhD2Jannik Helweg-Larsen, MD, DMSc3Niclas Rubek, MD4Lisa Toft Jensen, MD5Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Corresponding author: Caroline Asirvatham Gjorup, Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 København Ø, DenmarkDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkRhinocerebral mucormycosis (RCM) is a rare and rapidly progressive, destructive, angioinvasive fungal infection, which primarily affects immunocompromised patients. A high suspicion is required to diagnose RCM as initial clinical manifestations are often nonspecific. A cornerstone of the management is early diagnosis and radical surgery, which often requires complex reconstructive procedures.The optimal timing of reconstructive surgery is controversial.This case series presents the reconstructive perspective on four RCM cases treated with aggressive debridement, targeted antifungal treatment, and hyperbaric oxygen therapy followed by an early local flap or microsurgical reconstruction – to enable adequate local blood perfusion, antifungal treatment, and to decrease the risk of secondary infection. In all four patients, the early reconstructive surgery was successful without relapse of RCM or flap failure.We suggest aggressive surgical debridement till clear resection margins are obtained based on histopathology and/or microbiology, at a point which reconstructive surgery can be performed safely.http://www.sciencedirect.com/science/article/pii/S2352587821000607 |
| spellingShingle | Mette Stueland Wolthers, MD, PhD Grethe Schmidt, MD Caroline Asirvatham Gjørup, MD, PhD Jannik Helweg-Larsen, MD, DMSc Niclas Rubek, MD Lisa Toft Jensen, MD Surgical management of rhinocerebral mucormycosis: A case series JPRAS Open |
| title | Surgical management of rhinocerebral mucormycosis: A case series |
| title_full | Surgical management of rhinocerebral mucormycosis: A case series |
| title_fullStr | Surgical management of rhinocerebral mucormycosis: A case series |
| title_full_unstemmed | Surgical management of rhinocerebral mucormycosis: A case series |
| title_short | Surgical management of rhinocerebral mucormycosis: A case series |
| title_sort | surgical management of rhinocerebral mucormycosis a case series |
| url | http://www.sciencedirect.com/science/article/pii/S2352587821000607 |
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