Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review
Gunel Guliyeva1, Jeffrey E Janis1
1From the Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio.
Plastic and Reconstructive Surgery. Global Open
|January 22, 2024
Summary
Postsurgical pyoderma gangrenosum (PSPG) can worsen after surgery. Plastic surgeons must recognize PSPG early to prevent further injury and manage soft tissue defects effectively, though a standard treatment approach is lacking.
Area of Science:
- Dermatology
- Plastic Surgery
- Surgical Complications
Background:
- Pyoderma gangrenosum (PG) is a neutrophilic dermatosis linked to immune dysfunction and pathergy.
- It often co-occurs with systemic diseases or arises postoperatively.
- Plastic surgeons frequently manage PG-related defects, but surgical interventions can exacerbate the condition.
Purpose of the Study:
- To review the literature on postsurgical pyoderma gangrenosum (PSPG).
- To highlight the importance of early diagnosis and management for plastic surgeons.
- To analyze reconstructive techniques used for PSPG.
Main Methods:
- Systematic search of PubMed/Medline database (1958-2022) using keywords 'pyoderma gangrenosum' and 'surgery'.
- Selection of reconstructed PSPG cases.
- Inclusion of 28 patients who developed PG after various surgical procedures.
Main Results:
- The average time to PG presentation was 5.5 days, and diagnosis took 17 days.
- Diagnosis relied on histopathology after treatment failures; no scoring tools were used.
- Skin grafting was performed in 82.1% of patients, flap reconstruction in 42.9%, and 21.4% received both.
Conclusions:
- Accurate diagnosis and prevention of surgical injury are crucial for managing PSPG.
- Timely medical management is vital for improving patient outcomes.
- While reconstruction is possible, no standardized approach exists for PSPG management.
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