Zygomycosis is a rare but very aggressive
fungal infection mainly seen in immunocompromised patients. Immediate diagnosis and treatment with antifungal
therapy, control of underlying disease, and early surgical
debridement is essential. We present two cases of head
zygomycosis treated with systemic
liposomal amphotericin B, surgical
debridement, and immediate
free flap reconstruction. A retrospective chart review of two cases of
zygomycosis was performed; one with rhino-sino-orbital-cerebral and the other with scalp/cranial
zygomycosis. Both patients were treated with systemic
liposomal amphotericin B, aggressive
debridement, and immediate reconstruction following local control. The multidisciplinary team approach and the surgical technique are discussed. Patient 1 (with rhino-sino-orbital-cerebral
zygomycosis) died 2 weeks after diagnosis, and patient 2 (with scalp/cranial
zygomycosis) was disease free at 1-year follow-up. Both patients' flaps survived, although patient 2 needed to undergo an arterial revision with an interpositional vein graft within 24 hours of surgery. We concluded that to treat
zygomycosis effectively, a multidisciplinary team approach is needed, focusing on immediate diagnosis, empirical antifungal
therapy, reversal of underlying predisposing factors, and early surgical
debridement. When definitive
debridement results in critical structures being exposed, then early
wound closure with healthy vascularized tissue is indicated. In these two patients with exposed dura after definitive
debridement, immediate closure was performed to minimize the risk of meningeal and cerebral
infections.