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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Surgery RD1-811
Acceso en línea:	https://doaj.org/article/589401b99bd34610a02a868bf9369ff7
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spelling	oai:doaj.org-article:589401b99bd34610a02a868bf9369ff72021-12-02T05:02:00ZSurgical management of rhinocerebral mucormycosis: A case series2352-587810.1016/j.jpra.2021.04.013https://doaj.org/article/589401b99bd34610a02a868bf9369ff72021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352587821000607https://doaj.org/toc/2352-5878Rhinocerebral 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.Mette Stueland Wolthers, MD, PhDGrethe Schmidt, MDCaroline Asirvatham Gjørup, MD, PhDJannik Helweg-Larsen, MD, DMScNiclas Rubek, MDLisa Toft Jensen, MDElsevierarticleSurgeryRD1-811ENJPRAS Open, Vol 30, Iss , Pp 33-37 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811
spellingShingle	Surgery RD1-811 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
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.
format	article
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
title	Surgical management of rhinocerebral mucormycosis: A case series
title_short	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_sort	surgical management of rhinocerebral mucormycosis: a case series
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/589401b99bd34610a02a868bf9369ff7
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Surgical management of rhinocerebral mucormycosis: A case series

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