Post Surgical Pyoderma Gangrenosum in flap surgery: diagnostic clues and treatment recommendations
Nicholas Dhooghe1, Sebastiano Oieni2, Patrick Peeters3
1a Department of Plastic, Reconstructive and Aesthetic surgery , Ghent University Hospital , Ghent , Belgium.
Background:
Post Surgical Pyoderma Gangrenosum (PSPG) is a neutrophilic dermatosis causing aseptic necrotic ulcerations within surgical sites. It is often misdiagnosed as infection or ischemia and worsened by the inappropriate treatment. Therefore diagnostic clues must be identified and awareness for PSPG raised.
Methods:
We present two cases of PSPG after flap surgery and a review of the literature.
Results:
Seventeen cases of PSPG after flap surgery were found. Fever, pain and redness are the most common initial symptoms. In 63%, lesions were on the flap and the adjacent skin. In 63%, the donor site is also involved. Time to diagnosis was nine days to four years. Frequent debridement (89%) and administration of antibiotics (74%) illustrate the misdiagnosis of infection or ischemia. PSPG in flap surgery seems to be less associated with underlying diseases, than other forms of Pyoderma Gangrenosum. Corticoids are the most commonly used treatment. Of the 19 cases, 10 experienced partial or total flap loss.
Conclusion:
PSPG must be included in the differential diagnosis of postoperative wound problems. Recognizing the diagnostic clues can lead to early diagnosis and treatment with systemic immunotherapy. Associated diseases should be investigated and additional surgery can only be successful when associated with immunotherapy.
Insights
Post Surgical Pyoderma Gangrenosum (PSPG) is a rare condition causing wound breakdown after surgery. Early recognition and immunotherapy are crucial to prevent flap loss.
Area of Science:
- Dermatology
- Surgical Oncology
Background:
- Post Surgical Pyoderma Gangrenosum (PSPG) is a neutrophilic dermatosis presenting as aseptic necrotic ulcerations at surgical sites.
- It is frequently misdiagnosed as infection or ischemia, leading to inappropriate treatments that can exacerbate the condition.
Observation:
- This study reviewed two cases of PSPG following flap surgery and analyzed 17 additional cases from the literature.
- Common initial symptoms include fever, pain, and redness, often affecting the flap, adjacent skin, and donor site.
Findings:
- Misdiagnosis as infection or ischemia is common, evidenced by frequent debridement (89%) and antibiotic use (74%).
- The average time to diagnosis ranged from nine days to four years.
- Corticosteroids were the primary treatment, and 10 out of 19 cases resulted in partial or total flap loss.
Implications:
- PSPG should be considered in the differential diagnosis of postoperative wound complications.
- Early diagnosis and treatment with systemic immunotherapy are essential for successful outcomes.
- Investigating associated diseases and combining immunotherapy with surgical interventions can improve flap survival.
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