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Use of negative pressure wound therapy to successfully treat postoperative pyoderma gangrenosum following
Vincent van Grinsven1, Ernest Schouppe2, Tim Tollens3
1Department of General Surgery, University Hospital Leuven, Leuven, Belgium.
Introduction:
PG is a rare neutrophilic skin disorder with a variable clinical presentation, and diagnosis is often delayed. PPG typically presents as a necrotic ulcerative lesion with surrounding erythema and is often mistaken for a surgical site infection. Delayed diagnosis can lead to extensive morbidity and a prolonged healing time.
Case Report:
A 75-year-old male presented to the emergency department 2 weeks following laparoscopic appendectomy for acute appendicitis. He had fever and a suspected surgical site infection. Antibiotic treatment was initiated, and debridement was performed. Eventually, the diagnosis of PPG was made. Immunosuppressive therapy combined with NPWT was initiated. Complete wound healing was achieved 2 months after admission.
Conclusions:
Surgeons should have a high index of suspicion of underlying skin disorders when presumed postoperative wound infections do not respond to aggressive antibiotic and surgical treatment. Early multidisciplinary consultation should be considered. In the case of PPG, the authors of the present report advise early initiation of systemic immunosuppressive therapy combined with atraumatic wound care. NPWT should be considered as appropriate. Surgical debridement may be indicated in the setting of extensive necrosis or uncontrollable superinfection.
Insights
Pyoderma gangrenosum (PG) is a rare skin disorder often misdiagnosed as a surgical site infection. Early diagnosis and treatment with immunosuppressants and wound care improve healing outcomes.
Area of Science:
- Dermatology
- Surgical Pathology
Background:
- Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis.
- Its variable presentation often leads to delayed diagnosis, frequently mistaken for surgical site infections.
- Delayed diagnosis can result in significant morbidity and prolonged wound healing.
Observation:
- A 75-year-old male presented with fever and a suspected surgical site infection post-appendectomy.
- Initial treatment included antibiotics and debridement.
- The patient was eventually diagnosed with PG.
Findings:
- Treatment with immunosuppressive therapy and negative pressure wound therapy (NPWT) was initiated.
- Complete wound healing was achieved within two months.
Implications:
- A high index of suspicion for underlying skin disorders is crucial for infections unresponsive to standard treatment.
- Early multidisciplinary consultation and prompt initiation of systemic immunosuppressive therapy are recommended for PG.
- Atraumatic wound care and NPWT are advised, with surgical debridement reserved for extensive necrosis or superinfection.
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