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Tissue Expander for Pediatric Scalp Reconstruction Complicated by Fungal Infection With Aspergillus terreus
Shelley R Edwards1, Katherine C Benedict1, John Sullivan1
1University of Mississippi Medical Center, Division of Plastic and Reconstructive Surgery, Jackson, MS.
Eplasty
|March 15, 2023
Summary
Fungal infection of tissue expanders in pediatric scalp reconstruction, like Aspergillus terreus, can be devastating. Management requires prompt antifungal therapy, surgical debridement, and expander removal for successful outcomes.
Area of Science:
- Pediatric Plastic Surgery
- Infectious Disease Management
- Tissue Engineering
Background:
- Tissue expansion is a common method for pediatric scalp soft tissue reconstruction.
- Complications such as infection and expander exposure can occur, with fungal infections posing a severe risk.
Observation:
- A pediatric patient with a scalp soft tissue injury and skull fracture underwent craniectomy and subsequent tissue expander placement.
- The patient developed purulent drainage, leading to expander exposure and infection.
Findings:
- Intraoperative cultures revealed Aspergillus terreus and methicillin-sensitive Staphylococcus aureus.
- Treatment involved systemic voriconazole for fungal infection and cephalexin for bacterial infection, alongside clindamycin and ceftazidime, necessitating expander removal.
Implications:
- Fungal infections in tissue expanders, though rare, can lead to devastating outcomes.
- Successful management necessitates a combination of systemic antifungal treatment, surgical intervention, and device removal.
