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Surgical management of extensive peristomal pyoderma gangrenosum associated with colon cancer
Kosuke Ishikawa1, Toshiyuki Minamimoto, Takeo Mizuki
1Kosuke Ishikawa, MD Department of Plastic and Reconstructive Surgery, Hakodaate Municipal Hospital, Hakodate, Japan. Toshiyuki Minamimoto, MD, PhD, Department of Plastic and Reconstructive Surgery, Hakodate Municipal Hospital, Hakodate, Japan. Takeo Mizuki, RN, WOCN, Department of Nursing Care, Hakodate Municipal Hospital, Hakodate, Japan. Hiroshi Furukawa, MD, PhD, Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Hakodate, Japan.
Background:
Extensive peristomal skin ulcer due to pyoderma gangrenosum is difficult to manage and causes significant morbidity.
Case:
A 69-year-old man presented with a 10×7-cm painful peristomal skin necrosis during cancer chemotherapy for metastatic colon adenocarcinoma. The diagnosis of peristomal pyoderma gangrenosum was made on the basis of the presence of the skin necrosis with a well-defined, undermined, violaceous border. One month after the presentation along with daily cleansing and minimal debridement without immunosuppressive treatments, wound bed preparation was deemed sufficient for a split-thickness skin graft using negative pressure wound therapy for graft fixation. One month after the operation, the ulcer was completely healed and the patient could manage ostomy pouching independently. He died of cancer 5 months later; no recurrence of the ulcer was observed during this period.
Conclusion:
Peristomal pyoderma gangrenosum was successfully treated with skin grafting after local wound management. Negative pressure wound therapy was useful for skin graft fixation in the peristomal region.
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