Mycobacterium Ulcerans soft tissue defects: reconstructive challenges

Rachael Leung, Daniel Reilly, George Miller, Marc A. Seifman, David J. Hunter-Smith, Warren M. Rozen

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Mycobacterium ulcerans (M. ulcerans) infection is a growing concern in Australia, with several disease hotspots in south-eastern Victoria (Guest 2016). Cases at our institution, located within one such endemic area, increasingly require reconstruction of substantial mycobacterial soft tissue deficits. This article comprises a focused literature review of flap reconstruction outcomes in significant M. ulcerans defects and the impact of antibiotic choice, duration of antimycobacterial therapy and time to reconstruction in this context, as well as a short case series. Methods: A keyword search of Medline, Google Scholar and PubMed was conducted. In addition, four M. ulcerans flap reconstructions performed at our institution had case notes retrospectively reviewed for reconstruction indication, complications, outcomes and antibiotic therapy. Results: Sixteen articles met inclusion criteria, of which 11 referenced flap reconstruction of M. ulcerans soft tissue defects in some manner. Antibiotic regimens, peri-operative details and flap outcomes were either only briefly mentioned or not at all and were not the focus of any of the articles. We present four cases of dorsal hand M. ulcerans defect, which were reconstructed with fasciocutaneous anterolateral thigh flaps due to extensive soft tissue loss with extensor tendon exposure. Antibiotic regimens varied. Each procedure was undertaken with minimal complication and excellent functional outcomes. Conclusions: This review has identified the necessity of defining optimal reconstructive pathways in M. ulcerans soft tissue defects. Our cases demonstrate the successful use of fasciocutaneous flaps in refractory cases needing complex reconstruction. This paper presents the first review and case series on microvascular flap reconstruction of M. ulcerans defects. Level of Evidence Level IV, therapeutic study.

Original languageEnglish
Number of pages10
JournalEuropean Journal of Plastic Surgery
DOIs
Publication statusAccepted/In press - 7 Sep 2018

Keywords

  • Buruli ulcer
  • Free tissue flaps
  • Mycobacterium ulcerans
  • Perforator flap
  • Reconstructive surgical procedures

Cite this

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title = "Mycobacterium Ulcerans soft tissue defects: reconstructive challenges",
abstract = "Background: Mycobacterium ulcerans (M. ulcerans) infection is a growing concern in Australia, with several disease hotspots in south-eastern Victoria (Guest 2016). Cases at our institution, located within one such endemic area, increasingly require reconstruction of substantial mycobacterial soft tissue deficits. This article comprises a focused literature review of flap reconstruction outcomes in significant M. ulcerans defects and the impact of antibiotic choice, duration of antimycobacterial therapy and time to reconstruction in this context, as well as a short case series. Methods: A keyword search of Medline, Google Scholar and PubMed was conducted. In addition, four M. ulcerans flap reconstructions performed at our institution had case notes retrospectively reviewed for reconstruction indication, complications, outcomes and antibiotic therapy. Results: Sixteen articles met inclusion criteria, of which 11 referenced flap reconstruction of M. ulcerans soft tissue defects in some manner. Antibiotic regimens, peri-operative details and flap outcomes were either only briefly mentioned or not at all and were not the focus of any of the articles. We present four cases of dorsal hand M. ulcerans defect, which were reconstructed with fasciocutaneous anterolateral thigh flaps due to extensive soft tissue loss with extensor tendon exposure. Antibiotic regimens varied. Each procedure was undertaken with minimal complication and excellent functional outcomes. Conclusions: This review has identified the necessity of defining optimal reconstructive pathways in M. ulcerans soft tissue defects. Our cases demonstrate the successful use of fasciocutaneous flaps in refractory cases needing complex reconstruction. This paper presents the first review and case series on microvascular flap reconstruction of M. ulcerans defects. Level of Evidence Level IV, therapeutic study.",
keywords = "Buruli ulcer, Free tissue flaps, Mycobacterium ulcerans, Perforator flap, Reconstructive surgical procedures",
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Mycobacterium Ulcerans soft tissue defects : reconstructive challenges. / Leung, Rachael; Reilly, Daniel; Miller, George; Seifman, Marc A.; Hunter-Smith, David J.; Rozen, Warren M.

In: European Journal of Plastic Surgery, 07.09.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mycobacterium Ulcerans soft tissue defects

T2 - reconstructive challenges

AU - Leung, Rachael

AU - Reilly, Daniel

AU - Miller, George

AU - Seifman, Marc A.

AU - Hunter-Smith, David J.

AU - Rozen, Warren M.

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Y1 - 2018/9/7

N2 - Background: Mycobacterium ulcerans (M. ulcerans) infection is a growing concern in Australia, with several disease hotspots in south-eastern Victoria (Guest 2016). Cases at our institution, located within one such endemic area, increasingly require reconstruction of substantial mycobacterial soft tissue deficits. This article comprises a focused literature review of flap reconstruction outcomes in significant M. ulcerans defects and the impact of antibiotic choice, duration of antimycobacterial therapy and time to reconstruction in this context, as well as a short case series. Methods: A keyword search of Medline, Google Scholar and PubMed was conducted. In addition, four M. ulcerans flap reconstructions performed at our institution had case notes retrospectively reviewed for reconstruction indication, complications, outcomes and antibiotic therapy. Results: Sixteen articles met inclusion criteria, of which 11 referenced flap reconstruction of M. ulcerans soft tissue defects in some manner. Antibiotic regimens, peri-operative details and flap outcomes were either only briefly mentioned or not at all and were not the focus of any of the articles. We present four cases of dorsal hand M. ulcerans defect, which were reconstructed with fasciocutaneous anterolateral thigh flaps due to extensive soft tissue loss with extensor tendon exposure. Antibiotic regimens varied. Each procedure was undertaken with minimal complication and excellent functional outcomes. Conclusions: This review has identified the necessity of defining optimal reconstructive pathways in M. ulcerans soft tissue defects. Our cases demonstrate the successful use of fasciocutaneous flaps in refractory cases needing complex reconstruction. This paper presents the first review and case series on microvascular flap reconstruction of M. ulcerans defects. Level of Evidence Level IV, therapeutic study.

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KW - Mycobacterium ulcerans

KW - Perforator flap

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M3 - Article

JO - European Journal of Plastic Surgery

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SN - 0930-343X

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