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Postoperative Pyoderma Gangrenosum: A Clinical Review of Published Cases
Stanislav N Tolkachjov1, Aodhnait S Fahy2, Felipe B Cerci3
1Department of Dermatology, Mayo Clinic, Rochester, MN.
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.
Insights
Postoperative pyoderma gangrenosum (PG) is a rare skin condition at surgical sites, often mistaken for infection. Early diagnosis is key to prevent complications like wound breakdown, as treatments like antibiotics and debridement are common.
Area of Science:
- Dermatology
- Surgical Pathology
Background:
- Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis affecting surgical incisions.
- It is frequently misdiagnosed as a wound infection, and pathergy can complicate debridement.
- This condition has a lower association with systemic diseases compared to non-postoperative PG.
Purpose of the Study:
- To review and analyze the characteristics of postoperative pyoderma gangrenosum.
- To identify common comorbidities, affected sites, and treatment patterns in patients with postoperative PG.
Main Methods:
- A comprehensive literature search was conducted using PubMed, MEDLINE, and Mayo Clinic Libraries.
- Keywords included various forms of pyoderma gangrenosum and surgical-related terms.
- Manual review of titles for postoperative cases was also performed.
Main Results:
- Out of 136 patients, 66% had no associated systemic diseases; hematologic disorders were the most common comorbidity.
- Women showed more frequent breast involvement, while men had more chest involvement.
- Antibiotic therapy was initiated in 90% of treated patients, and 73% underwent debridement.
Conclusions:
- Postoperative PG is less frequently associated with systemic diseases than other forms of PG.
- Routine antibiotic therapy and debridement are common but can exacerbate wound breakdown.
- Early diagnosis of postoperative PG is crucial to prevent further complications and improve patient outcomes.