Surgical Management and Outcomes of Cutaneous Mold Infections in Immunocompromised Children. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Mauch, Jaclyn T.; Xu, Wen; Nathan, Shelby L.; Lin, Ines C.
• Is Part Of: Annals of plastic surgery. Volume 84:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: immunocompromised -- children -- cutaneous fungal infection -- surgical resection; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000002215
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Background: Cutaneous mold infections occur infrequently but can be life-threatening in immunocompromised children. The literature regarding its surgical management is limited. This study aims to describe the surgical management and outcomes of cutaneous mold infections in immunocompromised children. Methods: Hospitalized patients receiving a skin biopsy at a single pediatric hospital in 2003 to 2017 were identified. Inclusion criteria were immunocompromised status, younger than 21 years, and surgical excision of a confirmed cutaneous mold infection. Patient information, details of immunosuppression, operative details, and 6-month postoperative and disease outcomes were collected. Results: Seventeen patients (21 lesions) were identified with an average age of 6.8 years (range = 0.2–19.5 years). Affected anatomic regions included limb (15, 71%), chest (2, 10%), axilla, back, abdomen, and head (1 or 5% each). Excisions occurred, on average, within 1.7 days of initial biopsy (range = 0–7 days). When specified, margins were 0.5 to 2.0 cm, and surgeons used intraoperative fungal detection techniques in 8 cases (47%). Definitive closure was achieved by secondary intention/dressings changes (9, 43%), skin graft (7, 33%), a skin substitute (2, 10%), immediate primary closure (2, 10%), and delayed primary closure (1, 5%). Overall, 14 patients were alive 6 months after resection (82%). Conclusions: This study is the first to critically evaluate the methodology for surgical resection of cutaneous fungal infections in immunocompromised children. We suggest timely excision once diagnosed with, at minimum, 0.5-cm margins and intraoperative pathologic study when considering surgical treatment for this rare but serious infection.