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新冠后鼻眶上颌毛霉菌病缺损:我们使用游离皮瓣进行单阶段延迟重建的手术经验

Post-COVID-19 Rhino-Orbito-Maxillary Mucormycosis Defect: Our Surgical Experience with Single Stage Delayed Reconstruction Using Free Flap.

作者信息

Kala Prakash Chandra, Dixit Pawan Kumar, Katrolia Deepti, Karmakar Shilpi, Humnekar Akhilesh, Singla Priyanka, Singh Apoorva Pratap

机构信息

Department of Burns and Plastic Surgery, All India Institute of Medical Science, Jodhpur, Rajasthan, India.

出版信息

Indian J Plast Surg. 2024 Apr 23;57(5):379-386. doi: 10.1055/s-0044-1785489. eCollection 2024 Oct.

Abstract

The effect of the second wave of COVID-19 was immense in India, specifically in the form of vicious COVID-19-associated mucormycosis. A higher number of radical debridements are required for disease control in combination with antifungal drugs in cases of COVID-19-associated mucormycosis, which results in complex maxillofacial defects. We aimed to evaluate the clinical outcomes in patients with rhino-orbito-maxillary defects due to COVID-19-associated mucormycosis undergoing a single stage delayed free flap reconstruction.  This prospective, single-center, multisurgeon study was performed on eight patients with COVID-19-associated rhino-orbito-maxillary mucormycosis in the department of burns and plastic surgery. The postoperative clinical outcome was evaluated using the University of Washington Quality of Life Questionnaire for patient's quality of life (QOL), aesthetic numeric analog (ANA) scale for patient's satisfaction for aesthetics, and the functional intraoral Glasgow scale for speech and deglutition at 1 and 3 months.  The median age of the study patients was 40 years, with 75% of the patients being males. Diabetes mellitus (DM) was present in all the patients. Mucormycosis was diagnosed within the first 3 months of COVID-19 infection. Maxillary defect was present in 62.5% of patients, out of which 50% had bilateral maxillary defects. There was significant improvement in the QOL and the aesthetics of patients from 1 to 3 months (  < 0.001). Speech and deglutition were also improved at 3 months, but the difference was not statistically significant.  Single stage delayed free flap reconstruction can be advocated in patients with COVID-19-associated rhino-orbito-maxillary mucormycosis defect as there is considerable improvement in patients' QOL, aesthetics, speech, and deglutition over a period of time.

摘要

第二波新冠疫情对印度的影响巨大,尤其是引发了凶险的新冠相关毛霉病。对于新冠相关毛霉病,结合抗真菌药物控制病情需要进行更多的根治性清创术,这会导致复杂的颌面缺损。我们旨在评估因新冠相关毛霉病导致鼻眶上颌缺损的患者接受单阶段延迟游离皮瓣重建后的临床效果。

这项前瞻性、单中心、多外科医生研究在烧伤与整形外科对8例新冠相关鼻眶上颌毛霉病患者进行。术后使用华盛顿大学生活质量问卷评估患者的生活质量(QOL),用美学数字模拟(ANA)量表评估患者对美学的满意度,并用功能性口腔内格拉斯哥量表在术后1个月和3个月评估言语和吞咽功能。

研究患者的中位年龄为40岁,75%为男性。所有患者均患有糖尿病。毛霉病在新冠感染的前3个月内被诊断出来。62.5%的患者存在上颌骨缺损,其中50%为双侧上颌骨缺损。患者的生活质量和美学在1至3个月时有显著改善(<0.001)。3个月时言语和吞咽功能也有所改善,但差异无统计学意义。

对于新冠相关鼻眶上颌毛霉病缺损患者,可以提倡单阶段延迟游离皮瓣重建,因为随着时间推移,患者的生活质量、美学、言语和吞咽功能有相当大的改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7abc/11567769/1a17440c8b6d/10-1055-s-0044-1785489-i2382355-1.jpg

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