Mucormycosis management in COVID-19: Is immediate surgical debridement and reconstruction the answer?

ABSTRACT

Objective: Excessive use of corticosteroids therapy along with gross immunocompromised conditions in the Coronavirus Disease 2019 (COVID-19) pandemic has raised the risks of contracting opportunistic fungal infections. Here, we describe our experience with the implementation of a surgical protocol to treat and reconstruct Rhino-orbitalcerebral mucormycosis. Material(s) and Method(s) We conducted a prospective, single institution study utilizing our Mucormycosis Management Protocol. All patients included in this study underwent reconstruction after recovering from COVID-19. Wide local excision was performed in all cases removing all suspected and edematous tissue. Reconstruction was done primarily after clear margins were achieved on clinical assessment under a cover of injectable liposomal amphotericin B. Result(s) Fourteen patients were included. The average age was 43.6 years and follow up was 24.3 months. Thirteen patients had been admitted for inpatient care of COVID-19. Steroid therapy was implemented for 2 weeks in eleven patients and for 3 weeks in 3 patients. Eight patients (57.1%) had a maxillectomy and mucosal lining resection with/without skin excision, and six patients (42.8%) underwent maxillectomy and wide tissue excision (Maxillectomy and partial zygomatic resection, orbital exenteration, orbital floor resection, nose debridement, or skull base debridement). Anterolateral thigh flaps were used to cover defects in all patients. All flaps survived. No major or minor complications occurred. No recurrence of mucormycosis was noted. Conclusion(s) The approach presented in this study indicates immediate reconstruction is safe and reliable in cases when appropriate tissue resection is accomplished. Further studies are required to verify the external validity of these findings.