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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.
Background:
Tissue expansion is an effective option for soft tissue reconstruction of the scalp in the pediatric population. Unfortunately, this approach carries a high risk of such complications as infection and expander exposure. While bacterial infection of alloplastic materials is most frequent, when fungal infections occur, the outcomes can be devastating.
Purpose:
To inform the management of fungal tissue expander infections, this report describes a case of expander-based scalp reconstruction complicated by Aspergillus terreus infection in a pediatric patient.
Methods:
A patient who had blunt-force head trauma presented with soft tissue injury and depressed skull fracture requiring emergent craniectomy. After stabilization, a paucity of soft tissue coverage required further surgical intervention before reconstructive cranioplasty. Six months after her injury, two remote port subgaleal tissue expanders were placed. Subsequently, purulent drainage developed from the surgical incision.
Results:
Infection resulted in expander exposure requiring device removal and treatment with clindamycin and ceftazidime while awaiting culture results. Intraoperative cultures were positive for Aspergillus terreus and methicillin-sensitive Staphylococcus aureus, for which she received systemic voriconazole for 23 days and cephalexin for 10 days.
Conclusions:
Though tissue expansion remains a viable reconstructive option, fungal infection can be disastrous, requiring systemic antifungal therapy, surgical debridement, and expander removal.
Insights
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.
