Minimizing the risk of post-operative pyoderma gangrenosum

Abstract

A 61-year-old woman with seropositive rheumatoid arthritis developed numerous ulcers due to pyoderma gangrenosum at suture entry/exit sites following an arthroplasty of the right hip when interrupted silk sutures were used to close the skin. When a subsequent arthroplasty was performed on the left hip and subcuticular Dexon sutures were used to close the skin only two small ulcers developed. Sixteen cases of pyoderma gangrenosum developing in surgical wounds have previously been reported. We recommend that surgery in patients with a history of pyoderma gangrenosum is performed when the pyoderma is clinically quiescent, and that subcuticular sutures are used for skin closure, thus avoiding puncturing the skin surface.

Recurrent and treatment-resistant pyoderma gangrenosum, secondary to hidden underlying breast cancer

“…Other immunosuppressive drugs such as cyclosporine, azathioprine, mycophenolate mofetil, cyclophosphamide, chlorambucil and thalidomide have also been used successfully. 3,[15][16][17] Although there is not much literature on pulse therapy in PG, suprapharmacological doses of 4,18 In the present case, recurrence of PG was plausibly induced by the occult breast malignancy, which was initially undetectable by clinical examination. The malignancy was incidentally diagnosed only after one year of the initial presentation.…”

Pioderma gangrenoso en mamoplastía de reducción con pedículo inferior

“…El debridamiento simple y uso de injerto sobre las úlceras ha sido usado, pero con resultados que pueden ser desalentadores e incluso puede exacerbar la enfermedad i ; por otro lado, el manejo conservador lleva a cierre por segunda intención con importantes secuelas cicatriciales [10][11][12] . Si se prefiere optar por la alternativa quirúrgica, existen tres recomendaciones: primero, siempre usar terapia inmunosupresora preoperatoria y mantenerla por al menos 6 meses postoperatoria 21 ; segundo, evitar usar suturas epidérmicas, preferir cintas adhesivas, de esta forma se podría prevenir el desarrollo de PG en el sitio de sutura 22 ; tercero, si está considerando el uso de injertos, preferir aloinjertos con cobertura esteroidal para minimizar el dolor y favorecer la cicatrizacion 3 .…”

Port-Site Pyoderma Gangrenosum – A Rare Complication of Surgical Trauma

“…It more commonly affects patients who suffer from an associated systemic disease such as ulcerative colitis or rheumatoid arthritis; this is reflected in previous case reports of post-surgical pyoderma gangrenosum. [1][2][3] The early appearances of pyoderma gangrenosum in our patient mimicked a postoperative wound infection with pain, erythema, slough and superficial dehiscence at the wound site together with fever and leukocytosis. In view of the clinical findings of necrosis, the patient was started on intravenous antibiotics and underwent debridement of the affected area.…”