Pyoderma gangrenosum following bilateral deep inferior epigastric perforator flap breast reconstruction

Pyoderma gangrenosum (PG) is a relatively rare condition of ulcerative cutaneous dermatosis. Usually seen in the setting of systemic inflammatory disease, PG can be difficult to distinguish from infection. We present a case of an otherwise healthy 37-year-old woman, a BRCA-1 gene mutation carrier, who was evaluated several months after bilateral mastectomies with deep inferior epigastric perforator (DIEP) flap breast reconstruction with open wounds on the right DIEP flap. Multiple interventions were employed without success. As the disease progressed, the patient eventually developed new open wounds on the left DIEP flap as well. Ultimately, rigorous dermatopathology evaluation revealed PG, and the patient was treated appropriately with a high-dose prednisone course. The wounds healed completely, and despite significant cutaneous scarring, the breast reconstructions were salvaged. There was no fat necrosis within the DIEP flap tissue itself. PG should be considered in the differential diagnosis of chronic nonhealing cutaneous ulcers following surgical intervention that do not respond to standard initial care.