A lot of unfortunate patients suffering from or recovering from covid infection are facing a new problem now, the black fungus. The course of the treatment of the mucor is surgical and medical. Most commonly the areas infected by the mucor are mostly the sinuses initially. Later the infection may involve the orbit (eye socket), cheek bone(maxilla), palate and sometimes the base of skull and brain in which case the risk to life is very high. The initial treatment for black fungus infections is surgical removal of the infected material from sinuses and other areas initially combined with antifungal injections. But the infection sometimes involves the surrounding bones and muscles and soft tissues in which case those involved must be removed for quick control of infection and decrease the load on medicines.
With the decreasing incidence of corona virus infections, the number of black fungus infections are also on decrease. Many of those patients who survived the corona and black fungus may face a different problem now and may be in near future. That is the resultant disfigurement resulting due to the removal the infected bones and soft tissues of the face leading to multiple facial deformities, sinking of eyeball due to removal of floor of orbit, palatal fistulas leading to communication between nose and mouth, loss of jaw bones and many more.
These kinds of disfigurement presents a unique and very difficult challenge to the medical fraternity especially to plastic surgeons who perform the recontruction.
There are multiple options for reconstruction depending on the type of the defect. The process of reconstruction generally involves a basic principle of replacing the lost tissues with similar tissues harvested from the rest of the body.
Microvascular surgery takes a pivotal role in the reconstruction of especially bigger defects involving multiple segments of face. The most common defects of the face is loss of cheek bone or jaw bones both upper and lower jaws. Reconstruction of these defects generally involves transfer of fibula bone(thin leg bone) with its blood supply and some skin to the defect. Once the fibula is harvested it is shaped according the defect by using defined techniques of osteotomies and fixed with plates and screws. Then by using the microsurgical techniques the blood vessels of the bone are joined with the blood vessels of the neck to make the bone survive in the new place. But before embarking on this tedious process of reconstruction it is imperative that patient must be free of fungal infection completely and has to be symptom free for some time.
Some times the defect is small involving only the soft tissues like uneven prominences of cheek , sunken eye ball appearances. In such situations the underlying bones will be normal and hence filing up the defects will be sufficient. The best method is Autologous fat injections. This is done by harvesting the fat from patient’s thigh and the fat is processed and concentrated in a centrifuge. After centrifugation the residual concentrate is rich is fat cells. This concentrated fat is then injected in to the target areat to fill and thus correct the discrepancy.
Thus using the advanced Plastic surgical techniques reconstruction of the disfiguring facial deformities can be done in those patients coming out of the black fungus infection providing hope to many people who suffered immensely due to the Corona virus and sequele.
