The surgical approach to Pyoderma gangrenosum: A retrospective monocenter study
Alperen S Bingoel1, Nicco Krezdorn1, Alexander Kaltenborn2
1Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany.
Abstract:
Pyoderma gangrenosum is a diagnosis of exclusion. It occurs rarely and is frequently misdiagnosed. It can result in severe tissue loss, particularly in surgical units with little experience. Nevertheless, surgical treatment might be necessary for reconstruction, once the progression of these wounds is controlled. We aimed to characterize medical findings in Pyoderma patients with extensive defects to assess the surgical procedures and their outcome. A retrospective study was conducted at our centre over an 18-year period. Inclusion criteria were the diagnosis of Pyoderma gangrenosum and at least one surgical intervention. Descriptive statistics were used to analyse the data. Sixteen patients were included. The mean size of the lesions was noted with 12 × 8 cm. Surgical procedures comprised debridements/necrectomies, allograft conditioning, negative pressure wound therapy, skin grafts, and microvascular free flaps. Seven patients were discharged with healed wounds, six with minor wound healing disturbances. Three patients succumbed to their underlying diseases. Drug-based therapy can stop the progress of Pyoderma, but severe tissue loss can be a persistent problem. According to our data, reconstructive-surgical treatments (debridement, autologous and allogenous skin transplantation and microvascular free flaps) act as an integral component of the therapy and can be safe options for selected patients. Furthermore, we provide an algorithm that we follow at our department in severe cases.
Insights
Pyoderma gangrenosum often leads to severe tissue loss, frequently misdiagnosed. Surgical reconstruction, including skin grafts and flaps, can be a safe and integral part of managing these extensive wounds.
Area of Science:
- Dermatology
- Plastic Surgery
- Wound Healing
Background:
- Pyoderma gangrenosum (PG) is a rare inflammatory ulcerative condition.
- It is often misdiagnosed, leading to delayed or inappropriate treatment.
- Severe tissue loss is a common and challenging complication of PG.
Purpose of the Study:
- To characterize medical findings in patients with extensive PG defects.
- To assess the outcomes of surgical procedures for PG reconstruction.
- To evaluate the safety and efficacy of reconstructive surgery in managing severe PG.
Main Methods:
- Retrospective study over 18 years.
- Inclusion criteria: diagnosed PG and at least one surgical intervention.
- Descriptive statistics used to analyze data from 16 patients.
Main Results:
- Mean lesion size: 12 x 8 cm.
- Surgical procedures included debridement, allograft conditioning, negative pressure wound therapy, skin grafts, and microvascular free flaps.
- 7/16 patients healed, 6/16 had minor healing disturbances, 3/16 died from underlying diseases.
Conclusions:
- While drug therapy controls PG progression, severe tissue loss remains a challenge.
- Reconstructive surgery (debridement, skin transplantation, free flaps) is integral to PG management.
- Surgical treatments are safe and effective options for selected PG patients with extensive defects.
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