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<p>Mucormycosis is a fungal infection that can cause soft and hard tissue infections in the face, leading to postoperative complications such as oronasal fistulas and large palatal defects. Post-resection reconstruction presents functional and aesthetic challenges, and psychological issues like depression and anxiety are prevalent. Patient-specific implants (PSIs) have advanced the field by enhancing functional and aesthetic outcomes. However, challenges such as timing, post-operative waiting periods, and availability of healthy local flaps need to be considered before application. In a case report, a 60-year-old male patient presented with an exposed PSI in the right infraorbital region, accompanied by thin lower eyelid, entropion, and epiphora. He underwent reconstruction of the zygomaticomaxillary defect using a Patient-Specific Implant, Radial Forearm Free Flap, and Split thickness skin graft. The Paramedian Forehead Flap (PMFF) was successfully taken at the defect site without any signs of gaping or failure. This case report discusses the management of exposed PSI by two independent flap closures, demonstrating a simple, viable, and effective treatment option for soft tissue reconstruction with available local flaps. The two-flap technique is beneficial for the geriatric population, as it can effectively reconstruct infraorbital defects with limited lower eyelid availability, prevent ectropion, and improve tissue uptake, even with implants instead of healthy beds, considering the significant role of medical comorbidities and other factors.</p>

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Management of Exposed Patient Specific Implant (PSI) with Two Independent Flap Closure—A Novel Case Report & Review of Literature

  • 期刊论文

  • 发表日期：

    2025年11月18日

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  • Manikandhan Ramanathan,
  • Keerthana Ponvel,
  • A. I. Raj,
  • Vaibhav Sheshrao Bibe

摘要

Mucormycosis is a fungal infection that can cause soft and hard tissue infections in the face, leading to postoperative complications such as oronasal fistulas and large palatal defects. Post-resection reconstruction presents functional and aesthetic challenges, and psychological issues like depression and anxiety are prevalent. Patient-specific implants (PSIs) have advanced the field by enhancing functional and aesthetic outcomes. However, challenges such as timing, post-operative waiting periods, and availability of healthy local flaps need to be considered before application. In a case report, a 60-year-old male patient presented with an exposed PSI in the right infraorbital region, accompanied by thin lower eyelid, entropion, and epiphora. He underwent reconstruction of the zygomaticomaxillary defect using a Patient-Specific Implant, Radial Forearm Free Flap, and Split thickness skin graft. The Paramedian Forehead Flap (PMFF) was successfully taken at the defect site without any signs of gaping or failure. This case report discusses the management of exposed PSI by two independent flap closures, demonstrating a simple, viable, and effective treatment option for soft tissue reconstruction with available local flaps. The two-flap technique is beneficial for the geriatric population, as it can effectively reconstruct infraorbital defects with limited lower eyelid availability, prevent ectropion, and improve tissue uptake, even with implants instead of healthy beds, considering the significant role of medical comorbidities and other factors.