Postoperative Pyoderma Gangrenosum

Abstract

Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by PG at surgical incisions. It is often misdiagnosed as wound infection, and pathergy may complicate wound debridement. From September 1, 2013, through November 30, 2013, a literature search was conducted of articles published from January 1, 1978, through December 31, 2012. We referenced PubMed, MEDLINE, and Mayo Clinic Libraries using the keywords pyoderma gangrenosum, postoperative pyoderma gangrenosum, postsurgical pyoderma gangrenosum, superficial granulomatous pyoderma, pathergic pyoderma, and pyoderma gangrenosum associated with surgery, incision, breast, and wound dehiscence. In addition, all titles from PubMed with the words pyoderma gangrenosum were reviewed manually for postoperative cases. Of 136 patients, 90 (66%) did not have associated systemic diseases. If a comorbidity was present, hematologic disorders were most common. In addition, 29% (28) of women had predisposing disease vs 53% (19) of men. Women had more frequent breast involvement (P<.001); chest involvement was more common in men (P=.005). Girls and women aged 13 to 64 years had more frequent breast involvement (P=.01). Sites were distributed equally for men regardless of age (P=.40). Antibiotic drug therapy was begun and debridement occurred in 90% (110 of 122 treated patients) and 73% (90 of 123 available patients), respectively. Postoperative PG has less association with systemic disease than its nonpostoperative counterpart. Antibiotic drug therapy is routinely initiated. Affected sites are often debrided, causing additional wound breakdown. Early diagnosis may prevent complications.

A Case of Pyoderma Gangrenosum Misdiagnosed as Necrotizing Infection: A Potential Diagnostic Catastrophe

“…Often patients believe they have been bitten by a venomous spider or insect and seek early medical attention. Early aggressive tissue debridement generates more trauma and can compound the initial pathergic response [ 3 , 4 ], as was the case in our patient.…”

“…Rapidly progressing PG is often erroneously diagnosed as a necrotizing infection requiring urgent surgical intervention. Further surgical debridement of lesions compounds the initial pathergic phenomenon, which accelerates the necrotic process postoperatively [ 3 , 4 ]. Failure to re-evaluate the diagnosis after repeated attempts at surgical closure for nonhealing ulcers propagates the disease process and increases the risk of infectious complications with devastating patient morbidity.…”

Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum—A retrospective analysis

“…1 Postoperative PG as a primary phenomenon has been characterized in the literature as being less likely associated with systemic diseases, with onset usually in the first week after the procedure is performed. 2,3 Little is known about the risk for postoperative PG or recurrence/exacerbation of PG in patients with a known history of PG. Quantifying overall and procedure-specific risks for postoperative PG recurrence/exacerbation may affect medical decision making for patients with known history of PG, such as initiating prophylactic immunosuppression prior to procedures or avoiding/adjusting the timing of elective procedures.…”

Pyoderma gangrenosum after radical prostatectomy: case report

“…Post-operative PG is extremely rare and typically develops around surgical sites within the first 2 weeks post-operatively [ 3 ]. Therefore, it is often misdiagnosed as wound infection, and the pathergy may complicate wound debridement with rapid ulcer development [ 4 ]. This condition has clinical features analogous to infectious processes.…”