Vashistha Aakansha, Goil Pradeep, Charan Pahari Kaushal, Garg Paheli
Department of Plastic and Reconstructive Surgery, Sawai Mansingh Medical College and Hospital, Jaipur, Rajasthan, India.
Maxillofacial Surgery, SB Aesthteics, Gurugram, Haryana, India.
J Stomatol Oral Maxillofac Surg. 2025 Jun;126(3):102067. doi: 10.1016/j.jormas.2024.102067. Epub 2024 Sep 13.
This study is a prospective observational study conducted over two years from December 2020 to March 2023 at the Department of Plastic and Reconstructive Surgery.
To evaluate the outcomes of delayed reconstruction in patients with maxillectomy defects post-COVID-19 associated mucormycosis, focusing on safety, morbidity, and aesthetic results.
Fifty patients with post-COVID-19 mucormycosis and maxillectomy defects without skin involvement were included. These patients underwent radical debridement and were treated with Amphotericin B followed by Posaconazole therapy until clinical and radiological resolution of the disease. Reconstruction was performed after a minimum of six months post-maxillectomy. Flaps used for reconstruction included the radial forearm free flap (RAFF), anterolateral thigh flap (ALT), and free fibula osteomyocutaneous flap, planned using a 3D-printed model. Follow-up was conducted weekly for the first month and monthly for the next two months, with semiannual visits thereafter.
Of the 50 patients, 42 % were male, and 58 % were female, with a mean age of 43 ± 8.75 years. Most patients (88 %) were diabetic. Maxillectomy defects were categorized as type IIA, IIB, IIIA, IIIB, and IV based on the Cordeiro classification. Four flaps (8 %) required re-exploration, with three salvaged. Complications included marginal flap necrosis (4 %) and oro-nasal fistula (2 %). The average hospital stay was six days, extended to ten days for re-explored cases. Flap dimensions varied with the largest being 62 cm² for the free fibula flap.
Delayed reconstruction using free flaps in patients with post-COVID-19 mucormycosis maxillectomy defects without skin involvement is a safe approach with minimal morbidity. This method allows confirmation of disease resolution before major reconstructive surgery, resulting in excellent aesthetic and functional outcomes.
本研究是一项前瞻性观察性研究，于2020年12月至2023年3月在整形与重建外科进行，为期两年。
评估新冠病毒相关毛霉菌病后上颌骨切除缺损患者延迟重建的效果，重点关注安全性、发病率和美学效果。
纳入50例新冠病毒感染后毛霉菌病且上颌骨切除缺损但无皮肤受累的患者。这些患者接受了根治性清创术，先用两性霉素B治疗，随后用泊沙康唑治疗，直至疾病临床和影像学上得到缓解。在上颌骨切除术后至少6个月进行重建。用于重建的皮瓣包括桡侧前臂游离皮瓣（RAFF）、股前外侧皮瓣（ALT）和游离腓骨骨肌皮瓣，使用3D打印模型进行规划。术后第一个月每周随访一次，接下来的两个月每月随访一次，此后每半年随访一次。
50例患者中，42%为男性，58%为女性，平均年龄为43±8.75岁。大多数患者（88%）患有糖尿病。根据科代罗分类，上颌骨切除缺损分为IIA、IIB、IIIA、IIIB和IV型。4个皮瓣（8%）需要再次探查，其中3个成功挽救。并发症包括皮瓣边缘坏死（4%）和口鼻瘘（2%）。平均住院时间为6天，再次探查的病例延长至10天。皮瓣尺寸各不相同，游离腓骨皮瓣最大为62平方厘米。
对于新冠病毒感染后毛霉菌病且上颌骨切除缺损但无皮肤受累的患者，使用游离皮瓣进行延迟重建是一种安全的方法，发病率极低。这种方法能够在进行重大重建手术前确认疾病已缓解，从而获得极佳的美学和功能效果。
