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Postoperative pyoderma gangrenosum (PG): the Mayo Clinic experience of 20 years from 1994 through 2014
Stanislav N Tolkachjov1, Aodhnait S Fahy2, David A Wetter1
1Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Background:
Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by the development of PG-type lesions within surgical sites.
Objective:
We sought to characterize postoperative PG as a distinct subtype of PG for earlier recognition and prevention of improper therapy.
Methods:
We conducted a retrospective chart review of patients with nonperistomal postoperative PG at Mayo Clinic from 1994 to 2014.x
Results:
Eighteen patients had postoperative PG with an average age of 58 years. Fifteen (83%) were female. Among patients with postoperative PG, 4 (22%) had an associated systemic disease traditionally associated with PG. Sites of postoperative PG included 7 breast (38%), 7 abdomen (38%), 1 back, 1 shoulder, 1 ankle, and 1 scrotum, witxxh breast reconstruction being the most common surgery. The average time to symptoms was 11 days. No patients had a fever. Eight (44%) had documented anemia and 5 (27%) had leukocytosis. Antibiotics and systemic corticosteroids were initiated in 10 (56%) and 14 (83%), respectively. Debridement was done in 11 (61%) patients.
Limitations:
Small sample size and retrospective study are limitations.
Conclusion:
Postoperative PG is a rare surgical complication with predilection for the breast and abdomen of females and has less association with systemic disease than idiopathic PG. Early recognition may prevent unnecessary debridements and morbidity.
Insights
Postoperative pyoderma gangrenosum (PG) is a rare surgical complication. This study highlights its occurrence in females, particularly after breast and abdominal surgeries, emphasizing early recognition to prevent misdiagnosis and further harm.
Area of Science:
- Dermatology
- Surgical Complications
- Wound Healing
Background:
- Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis presenting as PG-type lesions at surgical sites.
- Characterizing postoperative PG is crucial for timely diagnosis and appropriate management.
Purpose of the Study:
- To define postoperative PG as a distinct subtype.
- To facilitate earlier recognition and prevent incorrect therapies.
Main Methods:
- Retrospective chart review of patients with nonperistomal postoperative PG.
- Data collected from Mayo Clinic between 1994 and 2014.
Main Results:
- Eighteen patients identified (average age 58, 83% female).
- Common sites: breast (38%) and abdomen (38%), often post-reconstruction.
- Average symptom onset: 11 days; 44% had anemia, 27% leukocytosis.
Conclusions:
- Postoperative PG is rare, predominantly affecting females on the breast/abdomen.
- Less associated with systemic disease than idiopathic PG.
- Early detection can prevent unnecessary debridement and reduce morbidity.
