Application of Surgical Management Combined with Photodynamic Therapy in the Treatment of Nontuberculous Mycobacterial Infections After Cosmetic Surgery.

Abstract

Background: In recent years, the number of patients with nontuberculous mycobacteria (NTM) infections caused by invasive procedures such as cosmetic surgery has been increasing. However, treating NTM infections presents significant challenges, with no standardized diagnostic or treatment guidelines currently available.

Methods: This study included 10 patients diagnosed with skin and soft tissue NTM infections following cosmetic surgery. Each patient underwent surgical treatment, followed by PDT after debridement. PDT was performed using topical 20% 5-aminolevulinic acid (ALA, 2 mL: 10 mg) applied to the wound periphery (2 cm margin), followed by a 3-hour incubation under light occlusion and activation with a 635 nm diode laser at an energy density of 120 J/cm². Exposure durations were dynamically adjusted (20-40 minutes) based on real-time pain tolerance. Weekly PDT sessions were administered, with total treatment duration individualized according to wound healing progression. Post-procedural pain was assessed using the Facial Expression Pain Scale (FEPS) and managed through a tiered protocol: ice compression for mild-to-moderate pain (FEPS 2-4) and NSAIDs/opioids for severe pain (FEPS >4). Antibiotics were selected based on the results of drug susceptibility testing.

Results: All ten patients achieved clinical cure, with a notable reduction in the duration of therapy. All patients were followed for over six months without recurrence of infection. Post-PDT pain was universally in all patients, with FEPS scores ranging from 2 to 7, and managed effectively by the final treatment. Transient adverse events included erythema (n=10) and pruritus (n=2), resolving spontaneously within 48 hours. No chronic complications were observed.

Conclusion: The combination of surgical intervention and PDT, along with appropriate antibiotic therapy, is a safe and effective approach for treating skin and soft tissue NTM infections after cosmetic surgery.

Methods: PDT was performed using topical 20% ALA (10 mg/session) applied to the wound periphery (2 cm margin), followed by 3-hour occlusion and 635 nm laser irradiation (120 J/cm²; XD-635AB). Exposure durations were adjusted dynamically (20-40 minutes) based on real-time pain tolerance. Weekly sessions were administered until wound resolution. Pain severity (FEPS) was managed via a tiered protocol: ice/NSAIDs for scores 2-4 and opioids for scores >4. PDT was performed using 20% 5-ALA activated by a 635 nm laser with a light dose of 120 J/cm².