Summary
If diagnosed late, post-surgical pyoderma gangrenosum (PSPG) is a rare, tricky and
potentially life-threatening complication. Once diagnosed, immunosuppressive agents
may provoke further complications. Well-intentioned extensive serial debridement may
cause deep skin and soft-tissue defects, requiring skin grafting and possible flap
surgery. The combination of necessary immunosuppressive treatment, protracted hospital
stay and broad-spectrum systemic antimicrobial therapy may encourage serious acquired
multidrug resistance (MDR). We report an unfortunate triad following breast reconstruction
of PSPG, full-thickness chest wall defect and MDR with Acinetobacter baumannii infection. Interdisciplinary treatment using free flap surgery and negative-pressure
wound therapy with instillation therapy (V.A.C.Instill® Wound Therapy) enabled survival
and complete wound closure.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Post-surgical pyoderma gangrenosum: a clinical entity.Acta Chir Belg. 2007; 107: 424-428
- Pyoderma gangrenosum complicating bilateral breast reduction.Br J Plast Surg. 2004; 57: 679-681
- Minimizing the risk of postoperative pyoderma gangrenosum.Br J Dermatol. 1992; 127: 45-48
- Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap- a lesson to learn.Brit J Plast Surg. 2000; 53: 437-447
- A new contribution to the study of geometric phagedism.Ann Dermatol Syphil (Paris). 1916; 9: 1-39
- Pyoderma (echthyma) gangrenosum. Clinical and experimental observations in five cases occurring in adults.Arch Derm Syph. 1930; 22: 655-680
- Pyoderma gangrenosum. Clinicopathological correlation and proposed diagnostic criteria.Int J Derm. 2004; 43: 790-800
- Skin Ulcers misdiagnosed as pyoderma gangrenosum.N Engl J Med. 2002; 347: 1412-1418
- Management strategies for pyoderma gangrenosum: case studies and review of literature.Ann Plast Surg. 2001; 47: 310-315
- Pyoderma gangrenosum: classification and management.J Am Acad Dermatol. 1996; 34: 395-409
Article info
Publication history
Published online: February 15, 2010
Accepted:
December 15,
2009
Received:
September 19,
2009
Footnotes
☆Details of any meeting at which the work was presented wholly or in part:
☆1. V.A.C Instill®. Symposium, Heidelberg, Germany, November 21, 2008,V.A.C.Instill® beim schweren Weichteilinfekt und nekrotisierender Fasciitis. M.V. Schintler, E.-Ch.Prandl, G. Kreuzwirt, S. Spendel, S. Scharnagl.
☆2. 1st International Workshops on Wound Technology within the framework of CPC, Portae Maillot, Paris, France, January 18–19, 2009. Experiences with V.A.C.Instill® Wound Therapy in Plastic and Reconstructive Surgery M.V. Schintler.
☆3. Dreiländerkongress VAC, Berlin, March 24–25, 2009 V.A.C.Instill® Wound Therapy in Managing Major Complications after Breast Reconstruction M.V. Schintler
Identification
Copyright
© 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
