Reconstructive surgery for mycetoma: a case series

Abstract

Background

Mycetoma is an under recognised but significant disease endemic in various countries and associated with high morbidity. Treatment is a combination of antimicrobial therapy, with surgery often reserved for refractory or delayed cases where functional sequelae are often ignored. This case series aimed to provide preliminary evidence for the role of reconstructive surgery in treating mycetoma.

Methods

Twenty-six cases of eumycetoma suitable for reconstruction post-excision were identified between 2013 and 2016 in three centres in Sudan. The choice of reconstruction was based on consensus of the treating team, and relevant end-points noted including patient satisfaction, mobility and complication rate.

Results

Mycetoma lesions affected primarily the limbs (n = 23), with three cases involving the gluteal region. A range of reconstructive options was used including skin grafting (n = 14), local flaps (n = 5) and regional flaps (n = 4). Three cases were closed primarily. No complications were noted, and disease recurrence was not found in any of the patients. Subjective interviewing revealed adequate patient satisfaction with cosmesis, and all patients reached a post-operative mobility status at least equivalent to their pre-morbid state.

Conclusions

This study demonstrates the feasibility of reconstructive surgery in selective patients with mycetoma as part of their treatment protocol.

Level of Evidence: Level IV, therapeutic study.

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