Post Surgical Pyoderma Gangrenosum in flap surgery: diagnostic clues and treatment recommendations
| Autor: | Nathalie Roche, Patrick Peeters, Sebastiano Oieni, Salvatore D'Arpa, Nicholas Dhooghe |
|---|---|
| Přispěvatelé: | Dhooghe N., Oieni S., Peeters P., Darpa S., Roche N. |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Post surgical Necrosis Tuberculosis Prognosi Settore MED/19 - Chirurgia Plastica Ischemia 030230 surgery Adrenal Cortex Hormone Risk Assessment Severity of Illness Index Surgical Flaps 030207 dermatology & venereal diseases 03 medical and health sciences Postoperative Complications 0302 clinical medicine Adrenal Cortex Hormones Post Surgical Pyoderma Gangrenosum medicine Humans flap surgery skin and connective tissue diseases Aged Wound Healing business.industry General Medicine Middle Aged Prognosis medicine.disease Dermatology Pyoderma Gangrenosum Surgery Surgical Flap Debridement Female Postoperative Complication Aseptic processing medicine.symptom business Breast reconstruction Complication Pyoderma gangrenosum Human |
| Zdroj: | Acta Chirurgica Belgica. 117:69-76 |
| ISSN: | 0001-5458 |
| DOI: | 10.1080/00015458.2016.1264729 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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