Primary cutaneous zygomycosis in an immunodeficient infant: a case report and review of the literature.

We report a case of primary cutaneous zygomycosis caused by Rhizopus species in an infant with a hematological malignancy. Multiple surgical debridements, skin grafting, and intravenous antifungal therapy were necessary to ultimately eradicate the infection. Zygomycotic infections are an emerging concern in immunocompromised patients because of their increased incidence as well as their potential to cause substantial morbidity through both emotional distress and impaired functionality. Because resection is a cornerstone of treatment for zygomycosis, the authors anticipate a growing need for plastic surgery involvement for both surgical debridement with limb and tissue-sparing procedures, and for reconstructive options that effectively treat the disease while preserving both function and esthetics. The plastic surgery literature is reviewed regarding surgical and reconstructive options for this population of patients. This case demonstrates the important role plastic surgeons play in the multidisciplinary treatment of zygomycotic and other opportunistic cutaneous infections.

Surgical treatment of severe hallux valgus: the state of practice among academic foot and ankle surgeons.

BACKGROUND: The purpose of this study was to evaluate the operative procedures used for treatment of severe hallux valgus by academic foot and ankle surgeons practicing in the United States. METHODS: A patient with severe hallux valgus deformity was developed as a hypothetical case: a 50-year-old woman with a severe deformity (intermetatarsal angle = 20 degrees; hallux valgus angle = 42 degrees). The patient was symptomatic with pain, did not improve with conservative measures, and wanted the deformity corrected. This case was sent to academic foot and ankle surgeons in a survey to determine their preferred operative treatment for this case. The overall response rate was 84% (128 of 153). To be included in the study group each surgeon had to have 1) foot and ankle patients comprising 50% or more of his clinical practice and 2) direct responsibility for teaching orthopaedic residents. One hundred and five respondents met the inclusion criteria and formed the study group; however, three surveys with invalid responses were deleted. RESULTS: Fifty-two percent (54 of 102) of the respondents chose a metatarsal osteotomy, 26% (26 of 102) a first metatarsophalangeal (MTP) joint arthrodesis, and 24% (24 of 102) a Lapidus procedure. Two respondents chose both an arthrodesis and a metatarsal osteotomy. Among the 54 respondents who chose metatarsal osteotomies, 24 used a Ludloff, 16 a proximal crescentic, eight a proximal chevron, two a scarf, two a distal chevron, and two other. In addition, secondary procedures to enhance the correction included a Weil osteotomy in 46% (47 of 102) and an Akin osteotomy in 30% (31 of 102). CONCLUSIONS: There was a wide variation in the type of procedure used to correct this severe hallux valgus deformity; approximately 50% of the respondents chose a metatarsal osteotomy, 25% chose a first MTP joint arthrodesis, and 25% a Lapidus procedure.