Resurfacing defects from mycobacterial skin and soft tissue infections using thoracodorsal artery perforator free flaps

Abstract

Purpose: Skin and soft tissue infections (SSTIs) caused by mycobacteria are rare and difficult to diagnose and treat. Furthermore, systematic treatment protocols for mycobacterial SSTIs have not been established. This study introduces a strategy with radical resection and resurfacing using thoracodorsal artery perforator (TDAP) free flaps. Methods: From December 2013 to February 2022, 13 patients with mycobacterial SSTIs underwent radical resection and reconstruction using TDAP free flaps. Exact mapping of the lesion extent was performed preoperatively with magnetic resonance imaging. When the extent was limited to soft tissue, resection and reconstruction were performed in a single stage. However, in cases with bone or joint involvement, two-stage reconstruction was applied with radical resection and negative-pressure wound therapy followed by resurfacing with a flap. Complex defects formed after resection were filled with a musculocutaneous or chimeric flap. All patients were administered antimycobacterial medications. Results: Mycobacterial infection recurred in one patient; therefore, a total of 14 cases of reconstruction were performed. Reconstruction was performed with a TDAP free flap alone in 10 cases, with a chimeric flap in three cases, and with a musculocutaneous flap in one case. The flaps ranged in size from 7×5 cm2 to 25×12 cm2 (mean, 97.2 cm2). The mycobacterial species identified were Mycobacterium tuberculosis (n=8) and nontuberculous mycobacteria (n=5). Conclusion: For mycobacterial SSTIs, radical resection followed by resurfacing and reconstruction using TDAP free flaps can be an effective surgical treatment strategy.