Assuntos
Dor Crônica/cirurgia , Denervação/métodos , Dor Intratável/cirurgia , Ablação por Radiofrequência/métodos , Articulação do Ombro/inervação , Dor de Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Plexo Braquial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Osteoartrite/complicações , Manejo da Dor , Estudos Retrospectivos , Lesões do Manguito Rotador/complicações , Dor de Ombro/etiologia , Nervos Torácicos/cirurgia , Resultado do TratamentoRESUMO
Cutaneous fusariosis is an opportunistic mycosis in immunocompromised patients. We present a novel variation of an immunocompromised patient who developed fusariosis in a previously irradiated site. Irradiation led to atrophy, contraction, fibrosis, barrier disruption, and an altered dermal environment in which the infection developed. Significantly, this is the first case report of fusariosis in a previously irradiated site of an immunocompromised patient. Treatment included debridement and voriconazole.
Assuntos
Dermatomicoses/etiologia , Fusarium/isolamento & purificação , Úlcera da Perna/etiologia , Infecções Oportunistas/etiologia , Radiodermite/complicações , Radioterapia/efeitos adversos , Adulto , Terapia Combinada , Ciclosporina/efeitos adversos , Ciclosporina/uso terapêutico , Desbridamento , Dermatomicoses/tratamento farmacológico , Dermatomicoses/microbiologia , Dermatomicoses/cirurgia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Transplante de Rim , Úlcera da Perna/tratamento farmacológico , Úlcera da Perna/microbiologia , Úlcera da Perna/cirurgia , Linfoma não Hodgkin/radioterapia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Pirimidinas/uso terapêutico , Neoplasias Cutâneas/radioterapia , Triazóis/uso terapêutico , VoriconazolRESUMO
BACKGROUND: Closing Mohs' defects is a challenging undertaking for surgeons. There are many methods, including linear repair, local flaps, and skin grafts. Traditionally, geometric flaps have been a mainstay, particularly in the cheek and forehead. However, many flaps violate basic principles of following relaxed skin tension lines; also, they often necessitate significant dissection. METHODS: All repairs of Mohs' facial defects performed sequentially from 2001 to 2008 by the senior author (J.F.T.) were reviewed. Chart review identified the size and location of the defect, method of closure, and complications. RESULTS: Chart review revealed 1354 reconstructions, with 475 direct repairs (35 percent). The highest rate of direct repair was seen in the forehead (77 percent). The lowest rate of direct repair was seen in the nose (7 percent). Analysis of cases revealed good results, with very low morbidity for direct linear closure. CONCLUSIONS: For many large defects, the simple method of direct linear closure often yields results superior to those of more time-consuming local flap options. Several dogmas of facial reconstruction are too unyielding, and the option of direct repair should not be overlooked. Traditional estimates of defect size requiring flap repair are incorrect; it is possible to close some large defects by direct approximation, with superior results.
