Combination of negative pressure wound therapy and systemic steroid therapy in postsurgical pyoderma gangrenosum after reduction mammoplasty; a case of proven efficacy and safety

Abstract

Pyoderma gangrenosum (PG) is a rare non-infective inflammatory disease of unknown etiology characterized by cutaneous papulo-pustoles that rapidly evolve into painful ulcerative lesions. Postoperative PG (PPG) is a clinical variant of PG in which pathergic response occurs at surgical sites. It is important to include PG in the differential diagnosis of breast ulceration. An incorrect diagnosis and treatment can potentially worsen the patient state, causing disfigurement with extensive scarring, an unpleasant aesthetic result and produce consequent psychological trauma. We report a case of PPG after bilateral breast reduction mammoplasty treated with negative pressure wound therapy (NPWT) as local treatment for wound dehiscence in combination with systemic steroid therapy. This synergism led to a good aesthetic result. NPWT improved wound perfusion, it decreased the exudate, and promoted adherence of the mammary gland to the pectoral muscle. After 31 days deep sutures were placed to directly close the wound and the patient was discharged. PPG is a rare, devastating occurrence after surgery. Surgeons must know that PPG is an evenience that can occur in otherwise healthy patients and must be considered in the differential diagnosis in case of necrotic ulcers and apparent infection status. NPWT resulted to have benefits in the treatment of PPG, with a role in limiting the size of the defect, avoiding pathergic self-reaction and allowing a faster recovery with higher chances of achieving a better result.

Treatment of Pediatric Pyoderma Gangrenosum With Modified Negative Pressure Wound Therapy and Intralesional Corticosteroids

“…As previously stated, subatmospheric pressure therapy increases tissue perfusion and granulation tissue formation while decreasing the bacterial load and interstitial edema 8. Case studies suggest that NPWT with systemic corticosteroids may be effective for PG 13,14. Additionally, Pichler and colleagues15 reported improvement of PG in 13 of 15 patients who received NPWT with split-thickness skin grafts, with complete resolution in 9 patients.…”

The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

“…Among the cases in which it was described, pressure levels greater than 125 mmHg were related to pain, while levels of 125 mmHg or less were not related to pain. 20,24,30,43,64,68,69 In Table 1, we summarized the studies including patients with PG treated with NPWT, but more detailed data can be accessed in Table S3. [70][71][72][73][74][75][76][77][78][79] As limitations of our review, we mention the publication bias and selective report that may have influenced the results.…”

PG‐TIME : A practical approach to the clinical management of pyoderma gangrenosum

“…There is some evidence that the compression reduces the inflammation in inflammatory ulcers such as PG and vasculitis 33 . NPWT can be used in the noninflammatory phase of PG to reduce the size of the lesion and to control the exudate 34 . It also favors the development of the granulation tissue 30 .…”