Surgical Debridement Of Necrotic Tissue Research Articles

Early Reconstruction with Locoregional-Free Flaps in Post-COVID-19 Rhino-orbital-cerebral Mucormycosis Craniofacial Deformities: A Single-Center Clinical Experience from India.

Aim of the Study Mucormycosis is a rare invasive and fatal fungal infection and its resurgence in coronavirus disease 2019 (COVID-19) patients has been a matter of grave concern. It is essentially a medical disease, but surgical debridement of necrotic tissues is of paramount importance leading to severe craniofacial deformities. In this case series, we present our experience with the feasibility of early reconstruction after surgical debridement. Case Series As a Dedicated COVID Center (DCH), the institute received the largest population of COVID-19 mucormycosis patients from the entire eastern region of the country between May 2021 and August 2021. More than 5,000 COVID-19 were admitted out of which 218 patients were diagnosed with mucormycosis. Nine patients, seven males and two females, with a mean age of 39 years with craniofacial mucormycosis underwent debridement and early reconstructions (2-4 weeks from first debridement and start of antifungal therapy) with free and pedicled flaps. All flaps survived and showed no evidence of recurrence. The average time of the early reconstruction after surgical debridement was 1.7 weeks once the course of systemic amphotericin B was received. Conclusion After aggressive surgical resection and a short course of antifungal therapy, early reconstruction can be done safely based on clinical criteria, as long as there is no evidence of hyphae invasion on wound edges in the intraoperative pathology examination.

AN AYURVEDIC APPROACH IN THE MANAGEMENT OF OSTEOMYELITIS TOES

Background – Osteomyelitis toe is commonly seen in patients who have peripheral neuropathy associated with diabetic mellitus. In Ayurveda, osteomyelitis can be correlated with Asthimajja Vidradhi1 or Dusta Vrana. Dusta vrana (infected wound) can cause loss of physical activity and it can produce a significant impact on the quality of life. This study mainly concentrates on Vrana Shodhan karma (surgical debridement) of dusta vrana (infected wound) and followed by application of Karanjadi Ghrita with Shaman Chikitsa which is performed to restore the function of toe and achieve adequate wound healing. Material and method- A Fifty-eight-year-old male pa-tient came to Shalya tantra OPD of our institute (GAC Raipur) with complaints of non-healing wounds on his great and second toe of left foot along with pain, swelling and discoloration of skin. Routine blood investigation and foot x-ray was taken and was diagnosed as osteomyelitis toe. Under all aseptic manner surgical debridement of necrotic tissue(slough) of wound was done by following classical guideline of Sushruta Samhita. Simultane-ously, wounds cleaned by lukewarm water and alcohol then after wounds was dressed in use of Karanjadi Ghri-ta and following internal medicine were given to the patient for three months like Triphala Guggulu, Kaishora Guggulu, Lakshadi Guggulu, Varunadi Kashayam. Result- Significant output were observed like pain, oedema is subsided, and wound was completely healed within 3 months. Conclusion- Multidisciplinary Ayurvedic ap-proach can play a good supportive role in managing critical conditions such as diabetic osteomyelitis toe and cosmetically preserve the body part and amputation can be avoided.

Osteomyelitis of the Ischium in a Hemodialysis Dependent Adult – A Rare Case Report

Introduction: Osteomyelitis of the pelvis is rare, and the correct diagnosis may be missed during the early stage when the correct treatment would be most beneficial. Osteomyelitis requires multidisciplinary treatment to cure or control symptoms. Case Presentation: A 71-year-old woman, with end stage renal disease on hemodialysis, presented in emergency department for purulent drainage of a right buttock swelling. A pelvic computer tomography (CT) revealed a collection of the gluteal musculature and an activated chronic osteomyelitis with one osteolytic lesion on right ischiopubic branch. The patient underwent surgical treatment, with need of two interventions. First, she was only submitted to surgical drainage of the abscess. She completed a cycle of antibiotic therapy, with good response. Two months later, she returns with fever and drainage of the surgical wound. A pelvic CT showed an area of bone destruction at right ischium, with an increase in bone sequestration. She underwent a partial orchiectomy and surgical debridement of necrotic tissues. A Klebsiella oxytoca, Proteus mirabilis and multidrug-resistant Staphylococcus epidermidis was isolated. She was on antibiotic therapy for 4 months. Three years later, she remains without new symptoms or signs of active osteomyelitis. Conclusion: Pelvic osteomyelitis represents a diagnostic challenge, because the symptoms and signs vary, depending on the initial site of infection, its duration and the direction of its spread. Osteomyelitis of the ischium is generally diagnosed in the late stage with complications. Treatment of pelvic osteomyelitis is challenging due to the anatomic constraints of the pelvis and the high degree of comorbidity in affected patients. A multidisciplinary approach is often required. This case of a chronic abscess with osteomyelitis of the ischium is rare and was neglected for months because of the absence of constitutional symptoms in a hemodialysis dependent woman.

Management of post-COVID mucormycosis at a tertiary care center in Northern India

PurposeOur study aims to compile data on the clinical presentation, pathological and radiological findings in cases of post-COVID mucormycosis, and present the management strategy used in our center.MethodsThis is a retrospective cohort observational study based at a tertiary healthcare institution in Northern India. All COVID-positive patients presenting with clinical features of mucormycosis were included in the study. They underwent complete otorhinolaryngeal, medical, and ophthalmological examination after thorough history taking. Biochemical tests, biopsy and imaging studies were done for all the patients. The treatment strategy included a multidisciplinary team approach, that is, intravenous antifungals as well as surgical debridement of necrotic tissue via Modified Denker’s approach or open maxillectomy, and orbital exenteration, if required. Patients were followed up for six months to look for recurrence.ResultsTwenty-three patients were studied, out of which 14 were males and 9 were females. Pathological findings of 13 out of 15 patients, who underwent surgical debridement revealed mucormycosis as a causative agent, received Amphotericin. Aspergillus was found in two cases which received Voriconazole. Eleven out of 20 patients who were treated in our hospital survived. Three patients were lost to follow up. The average hospital stay of discharged patients was 14 days.ConclusionPost-COVID mucormycosis was reported at an alarming rate after the second COVID wave in India especially after steroid therapies in diabetic patients. Thus a timely, aggressive, team approach using Modified Denkers or open maxillectomy along with proper intravenous antifungals is the key to survival in such patients.

Clinical outcome of multidisciplinary treatment of vulvar necrotising fasciitis.

Vulvar necrotising fasciitis (VNF) is a severe soft tissue infection associated with substantial morbidity and high mortality. At Stony Brook Medicine, US, patients with known or suspected VNF are treated by a structured multidisciplinary team consisting of members of the Departments of Emergency Medicine and Medicine, the Divisions of Gynecologic Oncology, Burn and Surgical Intensive Care Units, Infectious Disease and Plastic Surgery, and the nursing, nutrition, physical/occupational therapy and social work services. This is a retrospective review of patients presenting to Stony Brook University Hospital with VNF over an 18-month period. A total of 10 patients were treated for VNF during the study period. All patients were treated by the structured multidisciplinary team, including extensive initial surgical debridement by the gynaecologic oncologists. All patients survived to discharge. The results of this review demonstrated that prompt diagnosis, rapid implementation of appropriate antibiotic coverage, surgical debridement of necrotic tissue, and comprehensive care delivered by a structured multidisciplinary team contributed to positive clinical outcomes and decreased the risk of death from VNF.

Mucormycosis in COVID-19 patients with uncontrolled diabetes – the lethal triangle

Abstract BACKGROUND. Coronavirus disease 2019 (COVID-19) is one of the main global health problems of the twenty-first century, with more than one-hundred million people infected and more than two million deaths. The immunosuppression caused by SARS-CoV-2 infection along with steroidal treatment, hyperglycaemia and elevated ferritin levels creates the perfect environment for opportunistic infections such as mucormycosis. COVID-19-associated mucormycosis carries a high mortality rate. Therefore, in addition to antifungal therapy and aggressive surgical debridement of necrotic tissue, strategies to improve glycaemic index is the key factor in order to obtain a favourable outcome. MATERIAL AND METHODS. For the purpose of this article, the PubMed databases were searched using MeSH descriptors and the Boolean operator “AND” for the terms “rhinosinusal” and “mucormycosis” and “diabetes”, between February 2019 – December 2021. Clinical characteristics, therapy and outcome data were gathered and compared to what has previously been reported in the literature. Also, we report the case of a 68-year-old patient with uncontrolled type 2 diabetes mellitus, who developed mucormycosis during post-COVID period, to underline the need of early detection of this potentially deadly fungal illness. RESULTS. The clinical and imaging evaluation revealed no evidence of disease recurrence, at one- and two-months’ follow-ups. CONCLUSION. In this context, we would like to emphasize the importance of a high index of suspicion for mucormycosis in patients with COVID-19 infection, with pre-existing medical disorders, presenting with rhino-orbital or rhino-cerebral symptomatology.

Anu taila, an herbal nasal drop, suppresses mucormycosis by regulating host TNF-α response and fungal ergosterol biosynthesis.

The intractable, mucormycosis, caused by Mucorales primarily targets immunocompromised individuals. The first-line therapy, intravenous liposomal amphotericin B and surgical debridement of necrotic tissue, is contraindicative in individuals with compromised kidneys. This invokes a pressing need to identify safer treatment options. The antifungal effect of the classical nasal drop, Anu taila, against Mucor spp. was investigated through microbiological, cytological, analytical chemical (HPLC and GS-MS/MS) and scanning electron microscopic (SEM) approaches. Anu taila-pretreated spores germinated late, resulting in reduced infectivity, observed as milder monocytic immune response. Conversely, Anu taila-pretreated human THP-1 cells exhibited an improved immune response against Mucor spores, through TNF-α. Repeated Anu taila application rapidly abolished fungal microarchitectures than amphotericin B, evident from swift replacement of hyphae, sporangiophores and sporangia with fused biomass, in the SEM images. HPLC analysis showed that Anu taila treatment significantly reduced overall ergosterol content in Mucor biomass. Anu taila also downregulated sterol-C5-desaturase-coding ERG3 gene, crucial for ergosterol biosynthesis and resultant structural integrity, in Mucor spp. Taken together, Anu taila was found effective against Mucor spp., with both prophylactic and curative implications, which is attributable to the phytochemical composition of this classical nasal drop. The potential remedial effects of a classical nasal drop against an obdurate and challenging fungal infection are identified.

Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study.

Background:COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus -2 has proven to be the deadliest pandemic till date. Multiple covid waves have hit people hard on each part of the continent throughout the world. The second wave in India turned out to be highly infectious and virulent. Sudden surge in cases of mucormycosis after recovery of COVID surprised many clinician. Mucormycosis being a rapidly progressive and fulminant fungal infection required surgical debridement of necrotic tissue on emergency basis. The fatal combination of immunocompromised status, multisystemic involvement, and difficult airway in these patients pose numerous new challenges regarding anesthetic management. The present study was conducted to outline major concerns and the anesthetic management of patients undergoing surgical resection for rhinoorbital mucormycosis (ROM).Materials and Methods:A retrospective observational study was conducted in our institute for a duration of 2 months (June and July 2021). The data of all the cases posted for ROM was collected from the ENT and Anesthesia record register. Total 70 patients presented with mucormycosis, for surgical debridement out of which 25 patients were posted for surgery under general anesthesia or monitored anesthesia care (MAC). Demographic characteristics, comorbidities, duration of COVID illness, treatment taken during COVID (oxygen therapy/steroid intake), hemodynamic parameters, monitoring methods, and surgical procedures were recorded for each patient.Statistical Evaluation:SPSS version 21.0 was used for data analysis. Mean and SD were used to analyze the difference in mean values, and independent Student's t-test were utilized to compare the quantitative variables. Frequency distribution and percentage were used for qualitative parameters. Significant difference was accepted at P ≤ 0.05 with 95% CI (confidence interval) in the study.Results:Demographic data were comparable with respect to age, gender distribution, and ASA status. Mean duration of Covid illness was (12.18 ± 3.68) days. The mean HbA1C measured was (10.8 ± 1.42). Strong correlation was found between steroid intake and raised HbA1c in all patients (r = 0.77). Regarding the comorbidities, 24 (96%) patients had associated type 2 diabetes mellitus, 16 patients (64%) had pneumonitis, and 1 patient had pulmonary TB and hepatitis.Conclusion:Considering the perioperative risk associated with high HbA1C and pneumonitis, MAC was preferred in majority of cases. Strict hemodynamic monitoring, perioperative glucose control, difficult airway cart, metabolic and electrolyte balance and vigilant peri-operative monitoring are cornerstone for better outcome and short length of hospital stay.

Impact of Early Surgical Intervention of Plastic Surgeons on the Prognosis of Necrotizing Soft Tissue Infection.

BackgroundNecrotizing soft tissue infection (NSTI) is a rare, severe bacterial infection that causes rapidly progressive soft tissue necrosis from the skin to the muscle. The gold standard for treating NSTI is a prompt diagnosis, early surgical debridement of necrotic tissue, and antimicrobial therapy. This study investigated the relationship between the involvement of plastic surgeons and the clinical course of NSTI cases treated at Yokosuka General Hospital Uwamachi.MethodologyThis study involved 28 patients with NSTI who were treated at Yokosuka General Hospital Uwamachi. Patient background, outcomes (mortality and amputation), and days to the first surgery were compared in the early and nonearly plastic surgery intervention groups. Moreover, the duration of treatment was also compared in surviving patients. Differences between the two groups were analyzed using Fisher’s direct probability test, Mann-Whitney U test was used for comparison of continuous variables between the two groups, and Spearman’s rank correlation analysis was used for the bivariate correlation coefficient. The significance level was set at <5%.ResultsThere were eight and 20 patients in the early and nonearly plastic surgery intervention groups (14 in later intervention and six in nonintervention), respectively. A difference in the median number of days to the first surgery between the early (zero days) and the nonearly (two days) intervention groups was significant (p = 0.002). In the survival groups, the median treatment duration in the early (n = 8) and nonearly (n = 13) intervention groups was 44 and 82 days, respectively, which was significantly shorter in the early intervention group (p = 0.003).ConclusionsThe number of days until the first surgery and the length of the treatment period were significantly shorter in the early plastic surgery intervention group than in the nonearly intervention group.

“Mucormycosis” The Emerging Global Threat – A Complete Review

Mucormycosis is a life-threatening invasive fungal infection that affects people who are immunocompromised (haematological malignancies, solid organ transplantation, diabetes mellitus). Pulmonary, rhinocerebral, cutaneous, and disseminated infections are the most common. Controlling mucormycosis requires reversing the underlying problems. Treatment for mucormycosis also includes quick and vigorous surgery. Extensive surgical debridement of necrotic tissues is required. Finally, an antifungal treatment is required. High-dose liposomal amphotericin B (5 mg/kg/day) is the first-line treatment for mucormycosis. Antifungal chemotherapy has no set length; instead, it is determined by the remission of all related symptoms and results (usually 6-8 weeks). Posaconazole maintenance therapy/secondary prophylaxis should be recommended in patients who have a persistently weakened immune system. Keywords: Mucormycosis, Diabetes mellitus, Liposomal Amphotericin B.

Mucor in a Viral Land: A Tale of Two Pathogens.

Purpose:COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment.Methods:We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue.Results:All patients were male, mean age 60.5 ± 12 (46.2–73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86–404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3–42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy.Conclusion:Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.

A RARE FATAL CASE OF DISSEMINATED MUCORMYCOSIS IN AN IMMUNOCOMPETENT PATIENT DIAGNOSED ON AUTOPSY

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: We present a fatal case of undiagnosed disseminated mucormycosis in an immunocompetent patient that was diagnosed on autopsy. CASE PRESENTATION: 63-year-old male with history of deep vein thrombosis/pulmonary embolism on apixaban, atrial fibrillation, hypertension and morbid obesity presented with fever, abdominal rash and malaise for 3 days. He was discharged from the ED on oral doxycycline for possible Lyme disease. Patient had worsening generalized weakness and diarrhea and presented to the ED again two days later febrile, hypotensive and tachycardic. Labs were remarkable for white cell count of 19,800 and lactic acid of 4.3 mmol/L. He was started on broad-spectrum antibiotics: piperacillin-tazobactam, vancomycin and doxycycline. Patient’s condition significantly worsened with multiorgan failure and he was started on continuous renal replacement therapy. He was placed on four inotropic agents and was started on intravenous bicarbonate infusion in the setting of severe metabolic acidosis. The patient was intubated and mechanically ventilated. Procalcitonin level was found to be 26. Serologies for Rocky Mountain spotted fever, babesiosis, anaplasmosis and ehrlichiosis were negative. Respiratory pathogen panel, hepatitis panel, EBV IgM, CMV IgM, monospot test and leptospirosis antibody, anti-double stranded DNA, anti-citrullinated peptide, anti-histone antibody, anti-neutrophilic cytoplasmic antibody were all negative. Patient had some initial improvement and was weaned off the ventilator and vasopressors. Antibiotics were discontinued after 14 days. Unfortunately, however, patient became pulseless during dialysis and was reintubated. He simultaneously began to decompensate, and vasopressors were reinitiated. IV vancomycin, cefepime, metronidazole, and acyclovir were started with suspicion for disseminated Herpes Simplex infection due to new facial eschars as shown in figure 1. Repeat CT abdomen showed progressive pancreatitis, with normal lipase levels. Patient again went into cardiac arrest. After resuscitation, however, he was found to have a bowel perforation with repeat blood cultures growing Bacteroides thetaiotaomicron. He subsequently passed away within a day. Postmortem autopsy showed disseminated mucormycosis with extensive necrosis involving lungs, spleen, bowel, kidneys as shown in figures 2 and 3. DISCUSSION: Disseminated mucormycosis is a rare fungal infection with the mortality rate of approximately 100%. It rarely occurs in immunocompetent individuals(1). The only hope for treatment is rapid diagnosis, correction of predisposing factors, surgical debridement of necrotic tissue and antifungal therapy. (2) CONCLUSIONS: Our patient, who initially presented with nonspecific symptoms, eventually progressed to refractory shock, unresponsive to broad spectrum antibiotics. The suspicion for disseminated mucormycosis should not be confined to immunocompromised patients. Reference #1: Horger M, Hebart H, Schimmel H, Vogel M, Brodoefel H, Oechsle K, et al. Disseminated mucormycosis in haematological patients: CT and MRI findings with pathological correlation. Br J Radiol. 2006;79:e88–95. Reference #2: Amir Hossein Sarrami, Mehrdad Setareh,1 Masoud Izadinejad,1 Noushin Afshar-Moghaddam,2 Mohammad Mehdi Baradaran-Mahdavi,3 and Mohsen Meidani4. Fatal Disseminated Mucormycosis in an Immunocompotent Patient: A Case Report and Literature Review. Int J Prev Med. 2013 Dec; 4(12): 1468–1471. DISCLOSURES: No relevant relationships by Marc Filstein, source=Web Response No relevant relationships by Fizza Hirani, source=Web Response no disclosure on file for Rameez Phulphoto; No relevant relationships by Emily Zagorski, source=Web Response

Management of Mucormycosis

Mucormycosis is an aggressive disease with high (> 30–50%) mortality. Many attempts have been made to improve the outcome including global consensus guideline to manage mucormycosis. In this review, we discuss various aspects of the current management strategies of mucormycosis. New global consensus guideline not only addressed the management issues in developed countries but also recommended algorithm in a resource-limiting environment. Isavuconazole, a new water-soluble triazole with good pharmacokinetics and safety profile, has emerged as a promising agent with anti-Mucorales activity. The drug can be used even as first-line therapy with a moderate recommendation. New antifungal agents including Manogepix (MGX), VT-1161, and statins with anti-Mucorales activity are undergoing clinical trials. Different routes of antifungal administration for targeted delivery are being explored, viz., nebulization, topical treatment, intravitreal route. Early diagnosis and prompt therapy remain the cornerstone of mucormycosis management. Few recent studies reemphasized the need for combined management with surgical debridement of necrotic tissue, antifungal therapy, and reversal of underlying disease for a better outcome. New drug isavuconazole covers some of the gaps in management of patients with renal and hepatic compromise. Combination antifungal therapy remains controversial and requires prospective randomized studies. Adjuvant therapies are also not supported strongly due to the lack of clinical trials. The low incidence of the disease in developed countries is the main barrier for randomized studies. However, the disease is not uncommon in developing countries. Planning prospective, multi-center studies in those countries may help to standardize the dosage and duration of antifungals for therapeutic or prophylactic use in mono/combination therapy. Simultaneous maintenance of national/regional clinical registries and the discovery of novel therapeutic targets and diagnostic biomarkers are essential for aiding disease management. Additional studies on therapeutic drug monitoring, antifungal susceptibility testing, and correlation with the clinical outcome are needed to establish clinical breakpoints which can help in guiding therapy.

Rapidly progressive fatal orbito-cerebral mucormycosis in an immunocompetent patient following entry of an insect into his eye; a case report and literature review

Mucormycosis, an uncommon and rapidly progressive fungal infection, is mainly seen in immunocompromised patients. However, immunocompetent individuals can also be infected. Here, we present a rapidly progressive orbito-cerebral mucormycosis in an immunocompetent patient, who had a history of entry of an insect into his eye. We report an immunocompetent patient, who had a history of entry of an insect into his eye, presented with left eye panophthalmitis, cellulitis and loss of vision. He underwent orbital exenteration. Then, mucormycosis was diagnosed and amphotericin B was initiated. Left cavernous sinus and internal carotid artery involvement were found in brain magnetic resonance imaging (MRI) and cerebrovascular accident (CVA) was diagnosed. Surgical debridement of necrotic tissue was performed, and postoperatively, our patient died following CVA. Mucormycosis, as a fatal fungal infection, requires early diagnosis, appropriate early surgical and rapid antifungal management so that successful outcome can be achieved.

A Basic Algorithmic Surgical Approach for Nicolau Syndrome.

Background:Nicolau syndrome (NS) is a rare complication that develops after the administration of intramuscular diclofenac sodium. The etiology and surgical treatments of 11 patients with NS were evaluated and studies in the literature were examined. The aim of this study was to compose a basic algorithm for surgical approaches to treat NS.Materials and Methods:Eleven patients were evaluated for NS between December 2013 and January 2018. Two patients did not accept treatment, and nine patients underwent surgical debridement of necrotic tissues. The tissue defects of five patients were closed with a fasciocutaneous flap and, in four patients, the defects were repaired primarily.Results:No complications, such as wound infection, wound dehiscence, seroma, or flap necrosis, were encountered. Of the seven patients who received concurrent antibiotic therapy, no patient had any problems at their follow-up (2–30 months). The results were satisfactory from an aesthetic and functional point of view.Conclusion:NS was more frequent in women with a high body mass index and high fat in gluteal regions. We considered that any kind of medication could lead to NS. Different methods are discussed for treatment.

Managing Rhino-cerebral Mucormycosis: Institutional Experience

Introduction&#x0D; Rhinocerebral mucormycosis is a rapidly progressive life threatening opportunistic fungal disease and usually occurs in individuals with weakened immune system. It is caused by filamentous fungi of Mucorales from class Mucormycotina. After nasal inoculation, it usually spreads to orbit and brain. The common presenting complaints are purulent sinusitis, facial swelling, headache, complaints of vision or palatal ulceration. Despite the many recent advances in the diagnosis and management of mucormycosis, it still carries a high mortality rate.&#x0D; &#x0D; Materials and methods&#x0D; Here we present our experience in managing 30 such cases of mucormycosis that presented to our department between June 2016 to June 2018.&#x0D; &#x0D; Results&#x0D; All these patients were started on systemic antifungals with or without surgical debridement. The patients were followed up with repeated nasal endoscopies and imaging studies.&#x0D; &#x0D; Conclusion&#x0D; Successful treatment of mucormycosis consists of aggressive repeated surgical debridement of necrotic tissue, systemic antifungal therapy and immediate control of underlying systemic diseases. Since there are no clear-cut guidelines, the treatment needs to be individualized on a case to case basis.

Interventions for necrotizing soft tissue infections in adults

Interventions for necrotizing soft tissue infections in adults

A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report

BackgroundFournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene.Case presentationA 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued.ConclusionsSurgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.

Which Method Is Better to Provide Wound Healing in Fournier Gangrene: Dakin Solution or Conventional Antiseptic Dressings? A Retrospective Study

Fournier gangrene is described as necrotizing fasciitis involving the genital, perineal, and perianal area. Early surgical debridement of necrotic tissues, topical therapy, and antibiotics are fundamental in the treatment of Fournier gangrene. We aimed to compare the effects of Dakin solution and povidone iodine solution on patient outcomes by using the Fournier gangrene severity index (FGSI). The demographic data, comorbid diseases, local therapeutic interventions, FGSI, necessity of diverting colostomy or orchiectomy, hospitalization time, number of debridements, complications, and outcomes of 57 patients with Fournier gangrene were retrospectively analyzed. A total of 47 of 57 patients (82.5%) were male, and 10 patients (17.5%) were female, with a mean age of 62.3 ± 13.8 years (range, 27–85 years). The survivors were significantly younger than the nonsurvivors. The mean FGSI score was 4 (range, 1–9) in survivors, and mean FGSI score was 9 (range, 6–10) in nonsurvivors. FGSI score was significantly higher in the mortality group. The median hospital stay was 13 days (range, 3–34 days) in the Dakin solution group and 20 days (range, 1–41 days) in the povidone iodine group. Overall mortality rate was 17.5%. Advanced age had a statistically significant effect on mortality. The hospitalization time was significantly shorter in the Dakin solution group, and use of Dakin solution decreased the number of debridements. Dakin solution has favorable effects on hospital stay and the necessity of multiple debridements. Dakin solution seems to be a good and cost-effective choice for treatment in local wound healing.

Case 2: amputation site and infected toe on the diabetic foot

Severe infection resulted in the amputation of one toe and surgical debridement of necrotic tissue on another toe in the same diabetic foot. The postoperative wounds healed quickly and uneventfully following use of octenilin Wound Gel and a foam dressing.