Reconstruction in Rhino-Orbito-Cerebral Mucormycosis Survivors: A Systematic Review.

Background: The COVID-19 pandemic has affected the entire world tremendously. Particularly during the second wave in India, a dangerous complication followed in the form of COVID-19-associated mucormycosis. On June 7th, 2021, the Indian Union Health Minister stated that 28,252 cases of mucormycosis were reported from 28 states/Union territories in the country.

Methods: A PubMed search was conducted for English-language studies published from 1988 through May 22, 2021 using the terms "reconstruction AND mucormycosis."

Results: The search yielded 102 results. After excluding the articles not describing reconstruction in mucormycosis, 53 abstracts were screened. Then 34 articles dealing with reconstruction in non-ROC regions were excluded. The full text of 16 articles was reviewed. Additionally, 3 articles were identified from the reference search. Due to the aggressive debridements, rhino-orbito-cerebral mucormycosis survivors may be left with complex tissue defects with significant functional and aesthetic impairments. It is essential to offer reconstructive solutions that improve their quality of life. As far as the timing of reconstruction is concerned, the consensus is in favor of delayed reconstruction after ensuring that the infection has been eliminated/controlled and that there are no recurrences. The most common defects encountered were the ones that resulted from orbital exenteration and excision of a varying extent of the involved contiguous bony and soft tissue structures. Reconstruction with pedicled flaps was preferred rather than free flaps, especially in the cases where the infection was not eliminated completely. Adjuvant antifungal therapy was used in most of the cases. Long-term follow-up was considered essential to detect and treat recurrences.

Conclusions: A multitude of options are available for reconstruction in rhino-orbito-cerebral mucormycosis including skin grafts, pedicled flaps, free flaps and in some cases implants and prosthetics. These can be utilized to give as much as functional and aesthetic restoration as possible to the patient.