Extensive Debridement Research Articles

Treatment of infected calcific myonecrosis with chronically discharging sinus caused by iatrogenic aspiration: A case report.

Introduction and importanceCalcific myonecrosis (CM) is a rare, benign post-traumatic sequela which is often challenging to differentiate from soft tissue tumors. Infected CM is recalcitrant and sometimes requires invasive treatment despite its benign nature. We present a case of infected CM in which MRI and 201Tl scintigraphy proved useful for diagnosis and intralesional debridement with prolonged placement of a suction tube allowed for successful treatment.Case presentationA 71-year-old man had undergone repeated aspiration for swelling of the lower leg and presented with a sustained pyogenic discharging wound. He underwent intralesional debridement of purulent necrotic tissue followed by prolonged suction tube placement. Enterobacter cloacae was detected in the discharge, and specific antibiotics were administered. Once the wound closed, a new sinus recurred four months after surgery, warranting reoperation with debridement of the remnant fascia and necrotic tissue with suction tube replacement. The wound healed eight months after the first surgery with no signs of recurrence.Clinical discussionCM can be diagnosed based on its unique imaging features and a history of compartment syndrome. To avoid infection, CM must be treated conservatively without surgical invasions, such as biopsy or aspiration. Extensive debridement with a myocutaneous flap is nevertheless recommended for infected CM treatment, despite significant invasion including intraoperative bleeding being problematic.ConclusionMRI and 201Tl scintigraphy can help diagnose CM and avoid biopsy to exclude malignancy. Intralesional debridement of necrotic tissue with prolonged suction tube placement could be a valid treatment alternative to reduce the invasiveness of infected CM.

PO-621-07 OUTCOMES OF CLORHEXIDINE SCRUBBING WITHOUT CAPSULECTOMY VS. COMPLETE CAPSULECTOMY AFTER LEAD EXTRACTION FOR THE TREATMENT OF CARDIAC IMPLANTABLE DEVICE INFECTION

Complete capsulectomy has been proposed to reduce the risk of reinfection in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE). However, it is time consuming and requires extensive tissue debridement with a potentially higher risk of hematoma formation. To compare the outcomes of chlorhexidine gluconate (CHG) and saline pocket irrigation without capsulectomy vs. capsulectomy after TLE in CIED-related infection. Consecutive patients who underwent TLE for CIED-related infection were included. In the no-capsulectomy group, after complete device removal thorough scrubbing of the generator pocket with 20 cc of 2% CHG followed by irrigation with 1000 cc of saline was undertaken. The pocket was dried, and the wound was closed with separate intradermal absorbable suture. In patients undergoing capsulectomy, extensive tissue debridement aiming for complete removal of the capsule was undertaken. Patients were evaluated 6 weeks after the procedure and every 6 months thereafter. The primary safety outcome was hematoma formation; primary efficacy outcome was reinfection. Secondary outcomes included any adverse reaction to chlorhexidine, need for reintervention, and infection related mortality. A total of 94 patients were included between July 2013 and September 2020 (mean age 67.4±13.1 years; 32 female), out of which 39 patients underwent CHG pocket irrigation and 55 underwent capsulectomy after CIED extraction. Mean follow-up was 673 days. Six patients presented hematomas in the capsulectomy group vs. 0 in the CHG group (9.2%vs 0%, p=0.04). One patient in the CHG group and 3 patients in the capsulectomy group (2.6% vs 5.4%, p=0.49) died of worsening sepsis despite device extraction. There were no cases of reinfection, even though 50 patients (53.2%) had a new device. In patients with CIED infection, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation than standard pocket management with capsulectomy, without increasing the risk of reinfection or any adverse effects associated with chlorhexidine use.

The "Sombrero-Shape" Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene.

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

A rare case of cutaneous mucormycosis in the forearm: A case report.

Introduction and importanceCutaneous Mucormycosis (CM) is a less frequent type of fungal infection that can present with different skin lesions. Although these lesions appear to be benign and silent, CM rapidly progresses into the deeper layers. Given that no specific laboratory or imaging finding is described for the disease, the diagnosis is mainly based on history and physical examination. In addition, immediate debridement and antifungal agents must be commenced.Case presentationWe present a 43-year-old septic man who was hospitalized for his forefoot infection. During his admission, he developed a necrotic-like ulcer in his antecubital fossa. After initial debridement, pathology examination revealed the infection with mucormycosis. We administered intravenous liposomal Amphotericin B, and also multiple surgeries were performed. Unfortunately, the sepsis progressed to multiorgan failure, and the patient passed away.ConclusionCM requires emergent diagnosis and treatment. Early surgical interventions like extensive debridement and repetitive wound irrigation alongside systemic antifungal therapy are the key steps to preventing the progression of the disease.

Submandibular Gland Sialocele: A Rare Complication Following Open Treatment of Mandibular Fracture

Study Design Case report. Objective A sialocele is a subcutaneous cavity containing saliva, caused by trauma or infection in the parotid or submandibular gland parenchyma, by ductal stenosis or glandular duct laceration with subsequent asymptomatic dilation and swelling. Many cases of parotid sialoceles have been published, but few cases of submandibular sialoceles occurring as a result of surgical trauma have been reported. The purpose of this article is to inform clinicians and to raise awareness about an unusual post-operative condition of a sialocele of the submandibular gland after treatment of a sequele of a mandible fracture. Methods We report a case of a 33-year-old male with a submandibular sialocele in the submandibular gland, that presented on computed tomography as a 10 × 4 × 3 cm right submandibular fluid collection in the submandibular space, and developed after an open reduction and internal fixation of a mandibular fracture through a submandibular approach. Results In the clinical case, the patient presented with sequelae of untreated fractures of the right angle and parasymphysis of the mandible. Both fractures had unfavorable deviations for 2 months, with a diagnosis of pseudoarthrosis, or non-union. In the first surgical stage, extensive debridement at the stie of non-union and precise anatomical reduction and fixation of the bone segments were performed via a submandibular surgical approach. The treatment of the post-operative sialocele occurred in a second surgical procedure, which included surgical exploration and right submandibular gland excision. No complications related to the post-operative approach were observed in a follow-up of 1 month. Conclusions Given the paucity of publications and treatment strategies for submandibular gland sialoceles in the literature, we hope to build a foundation to guide clinicians who encounter these rare adverse events. Surgeons will have a better understanding of the risks involved when they encounter cases like this, where extensive surgical debridement was necessary due to skewed consolidation and extensive pseudoarthrosis after the absence of immediate treatment following the initial trauma.

Rehabilitation of post Covid mucormycosis maxillectomy defect with hollow obturator: A case series

India saw a devastating second wave of Coronavirus and along with the fatal nature of the disease the healthcare professionals saw a huge number of post Covid problems. One of these, is a fungal disease called mucormycosis which although an uncommon fungal infection can cause blackening of skin, redness, inflammation, sores and can encroach the eyes, lungs and even the brain. This warrants for extensive surgical resection and debridement of the necrosed areas resulting in maxillary and orbital defects. Intraoral defects in the maxilla cause communication with the nasopharyngeal complex. The surgically removed palate has a devastating effect on the appearance and speech of the patient. Obturator allows patients to eat and drink without letting the food to enter the oroantral cavities/ pharynx during mastication. This case series focusses on prosthetic rehabilitation of two patients with Hollow obturator post hemimaxillectomy in order to restore form and function.

Mastectomía e injerto cutáneo autólogo por fascitis necrotizante torácica

Hidradenitis suppurativa is an inflammatory skin disease that affects the folliculopilosebaceous unit. Necrotizing fasciitis of the thoracic wall is a rare entity that affects subcutaneous tissue and deep fascia. It represents a diagnostic and therapeutic emergency requiring broad spectrum antibiotics and extense surgical debridement, with high mortality rates. Other reported cases do not describe fascitis as an infection complicating hidradenitis, as the case of our patient. We present a case of a patient with a history of hidradenitis suppurativa, smoking, hypertension, diabetes mellitus with poor glycemic control, and dyslipidemia, admitted to our hospital with left breast and thoracic wall infection, with progression to necrotizing fascitis. Initially a preservative surgery was attempted but given the patient's comorbidities and the rapidly progressive infection, a mastectomy was required. In second time surgery, an autologous skin graft was performed. Despite the severity of the case, the patient overcame the infection after extensive surgical debridement, broad spectrum antibiotics and daily cures. In follow-up controls the patient presented good clinical condition.

Surgical Treatment for Advanced Thoracic Spinal Tuberculosis in Infants: Case Series and Literature Review.

Spinal tuberculosis (TB), or Pott's disease, is the most common form of osteoarticular TB. Early diagnosis and anti-TB drug therapy are the mainstays of treatment. However, in advanced stages, surgery is essential to correct spinal deformities and avoid neurological damage. Very few cases in young children requiring surgical treatment have been described. We present 2 cases of surgically treated thoracic spinal TB in patients under 2 years of age and review the literature on this entity in young children. Two male toddlers, aged 21 (patient 1) and 23 (patient 2) months, were admitted due to insidious systemic deterioration associated with neck stiffness and nonspecific abdominal pain in patient 1 and limping in patient 2. The findings of laboratory tests were unremarkable despite an increase in acute-phase reactants. After an extensive workup, results of a magnetic resonance imaging were consistent with spinal TB in both patients. Patient 1 underwent costotransversectomy of the left third and fourth ribs, debridement, T3-T4 corpectomy, and T2-T6 posterior fusion, to which an anterior rib autograft was added. Patient 2 had a right-sided thoracotomy performed at the apex in addition to debridement and T8 corpectomy; the resected rib was used as anterior structural autograft. Several samples of purulent, caseous material were sent for study. On follow-up, progression of proximal junctional kyphosis was evidenced in patient 1, requiring revision surgery to restore sagittal alignment; the patient was asymptomatic at 2-year follow-up. Patient 2 evolved satisfactorily without neurological sequelae and was asymptomatic at 4-year follow-up. Spinal TB in young children requires appropriate surgical treatment when presenting at advanced stages or having severe deformity or neurological compromise. Despite the challenges associated with young age and ongoing growth, surgery can be performed safely provided proper surgical expertise. After extensive debridement and decompression, priority should be given to restoring sagittal alignment and balance with stable and durable spinal reconstructions.

Clinicopathological Study of Mucormycosis in COVID-19 Patients: Experience From a Tertiary Care Center in South India.

Background: The coronavirus disease 2019 (COVID-19) pandemic has taken the world to different dimensions. With the surge of the second wave in India, the number of cases with mucormycosis has increased. Mucormycosis is a potentially life-threatening, opportunistic, invasive, fungal infection that can occur in immunocompromised states. The aim of the study is to analyze the clinicopathological parameters of patients with mucormycosis in the surge of the second wave of COVID-19.Materials and Methods: All cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in South India from March 2021 to June 2021 were included in the study. The patient details were retrieved from the Medical Records section. The patient characteristics, location, associated comorbidities, management and treatment outcomes were analyzed and compared to similar studies reported worldwide.Results: Of 58 cases, 38 (65%) were males and 20 (35%) were females. The ages ranged from 34 to 77 years. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 46 patients in reverse transcription polymerase chain reaction (RT-PCR) with high-resolution computed tomography (HRCT) Chest changes noted in 54 patients. Associated comorbidities were noted in 52 patients, with uncontrolled diabetes mellitus (46 patients; 88%) being the most common. Location was commonly in nasal and paranasal sinuses (43%), followed by orbital (2%), cerebral (10%) and pulmonary (8%) areas. Among the paranasal sinuses, the maxillary sinus was commonly involved. Mixed fungal infections (Aspergillus sp. and Candida sp.) were noted in eight (14%) cases. Oxygen therapy was given in 85% of cases; 30% of cases needed ventilator support; corticosteroid therapy was initiated in 49 patients, tocilizumab in six patients as treatment for mucormycosis. Amphotericin B was administered in 59% of patients based on clinical findings alone. After histopathological confirmation, 90% of them received amphotericin. Functional endoscopic sinus surgery (FESS) was done in 96% of cases, among them 45% underwent extensive surgical debridement and 15% underwent orbital decompression. Orbital exenteration (2%) was the other modality of management.Conclusion: Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.

Management of chronic empyema thoracis in children, a single center retrospective observational study

Abstract: Background: Chronic empyema thoracis (CET) is common in developing and developed countries despite advancement in diagnostic and therapeutic technologies. Some of the cases of CET can be managed with antibiotics and tube drainage alone, some of them managed with less extensive surgical procedure like video-assisted thoracoscopic surgery (VATS) or open decortication alone, while some of the complicated cases need extensive decortication and debridement of necrotic lung tissue or lobectomy. Our aim is to present our experience of management of cases of chronic empyema thoracis in children. Methods and Material: This is a retrospective observational study of cases, managed at tertiary care center with chronic empyema thoracis. Records of cases of CET admitted, referred or transferred to department of pediatric surgery at our center over last three years were studied. Demographic data, clinical, radiological profile, surgical/ non-surgical intervention, hospital stay, aetiology, outcome was analysed. Follow up was up to the last recorded outpatient visit. This study is a retrospective observational study with small number of cases statistical tool are not used to draw any statistical interference. Results: Twenty-nine cases with median age 3 years, male to female ratio was 25:4 were admitted over three years. Pre-operative bronchopleural fistula was seen in four. Five cases were managed conservatively, twenty underwent decortication alone while four cases required decortication along with lobectomy. Tuberculosis was detected in three cases. A pyogenic organism was identified in ten cases only. Post-operative ventilation was required in three patients. There was no mortality. All thrived well at 12-18 months follow up. Conclusions: Management of chronic empyema should be case based. Cases of CET in children can managed with conservative (with appropriate drainage of cavity, proper antibiotics, and nutritional build-up of child), thoracotomy and decortications alone or some time removal of disease lung also required depending on clinical and radiological finding of cases.

Necrotizing Soft Tissue Infections of the Perineum.

Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.

Multimodal management of Fournier’s gangrene with subsequent wound closure techniques

Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.

A case of sternal osteomyelitis during treatment with everolimus for recurrent breast cancer

BackgroundEverolimus is a mechanistic-target-of-rapamycin (mTOR) inhibitor bearing a potent antitumor effect against hormone receptor-positive breast cancer. Here, we report the case of a patient with recurrent breast cancer who developed osteomyelitis during the treatment with everolimus plus exemestane.Case presentationA 56-year-old woman with early-stage breast cancer underwent right mastectomy and axillary lymph node dissection at the age of 45. Four years after the surgery, she experienced relapse at the chest wall. Radiotherapy was performed on the chest wall, including the sternum, and denosumab was administered. After several regimens of hormonal therapies, everolimus in combination with exemestane was administered. Three months later, the patient visited our clinic because of continuous fever. A computed tomography scan showed an osteolytic change in the sternal bone with pneumomediastinum, which indicated sternal osteomyelitis. Extensive debridement followed by secondary reconstruction of the chest wall was successfully performed.ConclusionsEverolimus may cause osteomyelitis of the affected bone as a result of tumor necrosis. Everolimus-induced osteomyelitis may be manageable by extensive debridement performed without delay.

COVID-19 associated mucormycosis - An emerging threat.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly become a global threaten since its emergence in the end of 2019. Moreover, SARS-CoV-2 infection could also present with co-infection or secondary infection by other virus, bacteria, or fungi. Among them, mucormycosis is a rare but aggressive fungal disease and it mainly affects patients particularly with poorly controlled diabetes mellitus with diabetic ketoacidosis (DKA). We here did a comprehensive review of literature reporting COVID-19 associated with mucormycosis (CAM) cases, which have been reported worldwide. The prevalence is higher in India, Iran, and Egypt than other countries, particularly highest in the states of Gujarat and Maharashtra in India. Poor diabetic control and the administration of systemic corticosteroids are the common precipitating factors causing mucormycosis in the severe and critical COVID-19 patients. In addition, COVID-19 itself may affect the immune system resulting in vulnerability of the patients to mucormycosis. Appropriate treatments of CAM include strict glycemic control, extensive surgical debridement, and antifungal therapy with amphotericin B formulations.

Rhino-orbital Mucormycosis in a COVID-19 Patient: The First Case in Malaysia

Mucormycosis is an aggressive and potentially fatal fungal infection caused by fungi of the order Mucorales. There has been an increase in the number of cases of rhino-orbital mucormycosis in people with COVID-19, particularly in India. Rhino-orbital-cerebral mucormycosis is the most common manifestation of mucormycosis associated with COVID-19. We report the first case of rhino-orbital mucormycosis in a diabetic patient with SARS-CoV-2 infection in Malaysia. The diagnosis of mucormycosis was confirmed by histopathological examination, but the fungal culture and PCR results were negative. He was treated with antifungal therapy and had extensive debridement. Treatment of mucormycosis requires a multidisciplinary approach that includes addressing underlying risk factors, effective antifungal therapy, and surgical debridement.

Necrotizing Soft Tissue Infection of the Forearms in a Patient Using Intravenous Heroin: Case Report of Advanced Wound Management Improving Dressing Tolerance and Expediting Skin Graft

BACKGROUND: Necrotizing soft tissue infection (NSTI) is rare and characterized by rapid onset and spread of inflammation and necrosis. The infection starts within the fascia but can rapidly progress to include musculature, subcutaneous fat, and overlying skin. Its presentation is considered a surgical emergency. Persons who use intravenous or subcutaneous opioids are at higher risk of NSTIs. PURPOSE: The purpose of this case report is to describe the positive clinical outcome after consulting with wound specialists and using a dressing regimen to expedite more rapid wound healing, shortened time to skin graft, and improved pain tolerance in a patient with a history of intravenous and subcutaneous heroin use. CASE REPORT: The patient presented with an NSTI that required extensive debridement of the bilateral upper extremities. The acute surgical wound service was consulted. A dressing regimen consisting of hypochlorous acid–preserved wound cleansing, followed by carboxymethylcellulose fiber with 1.2% ionic silver covered by hydrocellular foam to promote a moist healing environment, was used to facilitate granulation. RESULTS: Healthy granulation tissue was noted 6 days after debridement. The improved rate of granulation and the patient’s tolerance to dressing changes secondary to decreased pain from these dressings significantly expedited the time to graft and wound healing. The patient underwent split-thickness skin grafting 10 days after debridement. There was 100% uptake of the grafts on postgraft day 8. CONCLUSION: The favorable clinical outcome suggests that early consultation with wound specialists and implementation of the dressing regimen were effective in this patient regarding improved pain control and healing. However, because the patient left against medical advice on hospital day 20, the clinical course could not be followed beyond the first few postoperative weeks.

Recovery from anaesthesia in post-COVID-19 mucormycosis debridement surgery: An observational study

Background: Mucormycosis has emerged as the most common lethal post-COVID-19 infection. Since the onset of the COVID-19 pandemic, anaesthesiologists have faced the challenge of anaesthetising post-COVID mucormycosis patients, which requires extensive surgical debridement. Various perioperative factors can have an impact on the recovery from the neuromuscular blockade of these patients. Aims and Objectives: This study was undertaken to observe the recovery pattern from the neuromuscular blockade and the impact of various factors on extubation time. Materials and Methods: The retrospective study included all post-COVID-19 mucormycosis patients who underwent debridement surgery under general anaesthesia in a tertiary referral hospital. All the pre-anaesthetic evaluation charts, treatment charts and anaesthetic management charts were reviewed. The following outcome variables at recovery from anaesthesia were noted: duration of surgery, duration of anaesthesia and extubation time. Results: A total of 72 patients underwent post-COVID-19 debridement surgery in the study period, of which 26 patients were excluded from the study and 46 patients were included in the analysis. The median extubation time was 32 min and interquartile range was 7–37 min. Seventeen (37%) patients were extubated in <15 min and 29 (63%) patients were extubated after 15 min. The shortest extubation time was 2 min, whereas the longest was 1440 min. Conclusion: Extubation time was prolonged when post-COVID patients underwent debridement surgery for rhino-orbito-cerebral mucormycosis. Although pre-operative and intraoperative factors can impact recovery from neuromuscular blockade, our study did not demonstrate such findings. Delayed extubation time may be related to the COVID illness rather than pre-operative risk factors.

Mucormycosis in post-covid patients: An epidemic in pandemic.

ABSTRACTRhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19) fungal infection in India. It is a lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucorales, most commonly with Rhizopus spp. Early diagnosis and timely management are essential. Other studies have shown high mortality up to 25–60%. However, in this study, the recovery rate is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms of prevention, diagnosis, and management of this fatal infection. We carried out a retrospective case series of six patients with a confirmed diagnosis of ROCM presenting to a single tertiary-level hospital during the second wave of covid 19 pandemic. Clinical details for each case was obtained from the hospital information system. A total of six patients (five males and one female) were diagnosed with ROCM during this period. Out of six patients, four had diabetes mellitus and all were on steroid treatment during COVID-19 infection. The most common presenting features were headache (100%), facial pain (80%), orbital swelling (80%), and earache (20%). Most of the patients had sinusitis as a predominant finding in preop magnetic resonance imaging (MRI) at presentation. All patients received liposomal amphotericin B (LAmB) as the first line of treatment and subsequently shifted to posaconazole. The overall recovery rate was 100% and patients were discharged. ROCM infection is very hard to treat. The studies have shown cases with late presentation spreading beyond paranasal sinuses. Early intervention and treatment with antifungals and extensive surgical debridement resulted in the full recovery of all six cases.

Auricular Mucormycosis Following Burn Injury: A Case Report with Literature Review

Objective: Mucormycosis is a dreaded clinical entity caused by filamentous fungi of the order Mucorales. Traumatic mucormycosis mainly occurs in civilian trauma, burns and vehicle accidents. Herein, we present a rare case of burn-related mucormycosis in a 29-year-old healthy male patient. Methods: The patient was referred to our hospital after being involved in a car accident with vehicle explosion and burn injury. 20 days after admission to our hospital, a new discharge from the left ear was noticed. Microbiological results revealed high suspicion of fungal infection and pathologic examination of necrotic cartilage revealed aseptate hyphae of mucormycosis Results: A prompt parenteral liposomal Amphotericin B was initiated, local control of the disease by extensive surgical debridement was performed, including total excision of both auricles and cartilaginous parts of the external auditory canals. Excisions were done until a healthy, bleeding tissue was obtained. The wounds healed completely without any recurrence Conclusions: Mucormycotic infections are uncommon in patients with burns; however, when they are present, they usually occur as a cutaneous burn wound infection and remain difficult to treat and is often lethal. This necessitates prompt and early diagnosis, control of risk factors, surgical debridement of necrosed tissue and antifungal drugs. Amphotericin B is the antifungal of choice for the treatment of mucormycosis. Since inoculation of soil-dwelling moulds into wounds can occur at the time of injury, the context in which burns occur needs to be considered to evaluate the risk of mucormycosis, especially in auricles which are likely at increased risk, probably because they protrude from the head and come more in contact with the ground.

Necrotising fasciitis following a monkey bite

Abstract Necrotising fasciitis (NF) is rapidly spreading bacterial infection of a facial plane. It has a higher mortality rate in patients with diabetes and immunocompromised state. The initial presentation mimics cellulitis and most of the cases are misdiagnosed. Delayed diagnosis and treatment increase mortality by nearly 100%. Our patient had developed NF with septic shock following a monkey bite. The patient underwent prompt fasciotomy along with extensive wound debridement. Later patient underwent secondary suturing with a skin graft for wound cover. NF following money bite is not reported in the literature till now. Hence, early diagnosis and prompt surgical debridement in monkey bites will reduce the incidence of mortality due to NF.