Clinical Efficacy of Human Split-thickness Skin Allograft in Patients With Pyoderma Gangrenosum: A Case Series

Abstract

Introduction. Pyoderma gangrenosum (PG) is an uncommon inflammatory skin disease that is characterized clinically by the development of painful pustules that subsequently progress to large cutaneous ulcers. There is no universally effective treatment for PG, and a combination of local and systemic therapies is often used to manage it. Biologically active, cryopreserved human skin allograft (BSA) has become a standard part of the treatment algorithm for complex nonhealing wounds. These allografts facilitate the wound healing cascade by delivering the essential biologically active compounds of fresh skin to the wound bed and promoting wound bed revascularization. Objective. The purpose of this case series was to illustrate how the use of human split-thickness allografts positively contributes to wound healing in patients with PG. Case Presentations. Five cases highlighting the efficacy of a BSA in achieving clinical wound healing in patients with complex PG ulcerations are presented. Clinical findings appear to indicate that the positive effect of BSA in combination with systemic therapies on wound beds in patients with PG is because of a combination of both the unique alterations in the patient’s immune system in addition to the possible delays in clearance of cellular components of the allograft, which promote the strong inosculation and revascularization necessary for wound healing. Conclusions. The BSA studied herein appears to aid in wound healing because it has natural components found in human skin that facilitate wound healing, and it eliminates the potential for pathergy because no graft harvesting from the host is performed. These allografts can be applied numerous times, and each has the major essential components of human skin wound healing for a more rapid and complete epithelialization.

The role of split‐thickness skin grafting in the treatment of vasculitic and pyoderma gangrenosum ulcers in a multidisciplinary wound centre

“…However, as our study was essentially descriptive in nature, optimal timing of surgery should be evaluated more thoroughly in future studies. Also, in addition to split thickness skin grafting, dermal matrix, 35 allograft skin, 36 xenograft skin, 11 or even a free flap reconstruction 37 could be considered in highly selected cases with atypical ulcers after multidisciplinary discussion, but these treatments were not evaluated in this study.…”