Successful management of cutaneous mucormycosis by delaying debridement.

Abstract

Mucormycosis is a frightening medical condition which has baffled clinicians all over the world. Cutaneous mucormycosis is, in particular, extremely invasive, leading to high rates of morbidity and mortality. Timely intervention with antifungal drug Amphotericin B and early radical debridement are keys for favorable outcome.Three consecutive patients died of cutaneous mucormycosis despite being treated with Amphotericin B and an early extensive debridement. With disappointing results in these patients, the treatment protocol was changed. Instead of early aggressive surgical intervention, the debridement was withheld for minimum 10 days or more, until Amphotericin B started to show its effect. Debridement was carried out conservatively after 10 days. The resultant raw area was covered with the split-thickness skin graft later.The concept of "Delay the Debridement" was efficacious in the successive 5 patients with minimum morbidity and less reconstructive requirements. Our study contradicts the popular wisdom of the necessity of early vigorous debridement. We think that the timing of debridement is one of the most important determinants of mortality.The scientific reasons for delaying the debridement have been discussed. This appears to be the first report of successful management of cutaneous mucormycosis by delaying the debridement.