Sarr L, Dembélé B, Limam M, Daffé M, Diouf A B, Gueye A B, Diao S, Diop M, Coulibaly N F, Diémé C
Service orthopédie-traumatologie, Hôpital Aristide Le Dantec, Dakar, Sénégal.
Service d'orthopédie-traumatologie, Hôpital Cheikh Zayed, Nouakchott, Mauritanie.
Bull Soc Pathol Exot. 2019;112(4):195-201. doi: 10.3166/bspe-2019-0103.
The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.
真菌性足菌肿的治疗主要是手术治疗。这种类似癌症治疗的手术在骨骼受累时包括截肢。截肢后的复发很少见，并涉及手术指征的问题。我们报告了5例腿部或大腿截肢后真菌性黑粒足菌肿复发的病例。病例1：一名52岁的患者，膝部足菌肿已发展8年。无手术史。进行了大腿截肢并清扫了神经节。手术后一年，患者在截肢残端和淋巴结清扫部位出现复发。在截肢17个月后进行了髋关节离断术。病例2：一名25岁的患者，足部黑粒足菌肿伴骨炎已发展10年。进行了腿部截肢。患者在术后15个月腘窝处复发。提出了大腿截肢的指征，但患者拒绝。病例3：一名30岁的女性，膝部黑粒足菌肿伴骨骼受累超过10年。进行了大腿截肢，术后9个月她在截肢残端出现复发。尽管决定进行手术翻修，但她还是失明了。病例4：一名43岁的患者，在2000年截肢前至少对足部和腿部的足菌肿进行了5次手术。复发发生在截肢后一年。截肢18年后，由于病变扩展至骨盆，再次手术困难。病例5：一名50岁的女性患者于2012年在毛里塔尼亚接受手术（因膝部足菌肿进行大腿截肢）。她于2018年在截肢残端出现复发。提出了髋关节离断的指征，但患者拒绝。这些复发通过在保留节段上颗粒的持续存在得到证实。它们提出了截肢水平的问题，因此也提出了术前规划的问题。良好的术前规划可以优化手术过程并避免某些复发。
