Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report
Identifieur interne : 000258 ( Main/Exploration ); précédent : 000257; suivant : 000259Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report
Auteurs : Justin T. Zelones ; John F. NigrinySource :
- Plastic and Reconstructive Surgery Global Open [ 2169-7574 ] ; 2017.
Abstract
Pyoderma gangrenosum (PG) is a rare skin disorder of the neutrophilic dermatoses spectrum that can mimic wound infections in surgical patients. PG after breast surgery has been reported but in limited amounts in autologous breast reconstruction patients. We present the first case of PG after a delayed bilateral deep inferior epigastric perforator flap breast reconstruction in the setting of systemic disease along with a systematic review.
PubMed, Ovid, and Web of Science were systematically searched to obtain cases of PG after autologous breast reconstruction. Sixty articles were identified but only 16 were relevant to this study.
Systemic disease was present in 2 patients (13%). Wound onset occurred typically 5 days after surgery. Fever and/or leukocytosis was observed in 10 patients (63%). Wound cultures were positive in 2 patients (13%). Donor-site wounds were present in 9 patients (56%). Bilateral breast wounds were present in 67% of bilateral cases. Debridement was performed in 10 cases (63%). Skin graft or substitute was performed in 6 cases (38%). Resection of autologous flap was performed in 3 cases (19%). All patients were treated with systemic steroids (81%) and/or immunosuppressive medications (50%). Complete wound healing occurred by 4 months on average.
If early ulcerative wounds develop at multiple sites after autologous breast reconstruction with worsening after debridement and antibiotic therapy, then PG should be considered. It is imperative that an early diagnosis and subsequent treatment with steroids and/or immunosuppressive medications be initiated so further surgical procedures, flap loss, and scarring can be minimized.
Url:
DOI: 10.1097/GOX.0000000000001239
PubMed: 28507842
PubMed Central: 5426861
Affiliations:
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Nigriny</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28507842</idno><idno type="pmc">5426861</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426861</idno><idno type="RBID">PMC:5426861</idno><idno type="doi">10.1097/GOX.0000000000001239</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">004577</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004577</idno><idno type="wicri:Area/Pmc/Curation">004576</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004576</idno><idno type="wicri:Area/Pmc/Checkpoint">000121</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000121</idno><idno type="wicri:Area/Ncbi/Merge">009083</idno><idno type="wicri:Area/Ncbi/Curation">009083</idno><idno type="wicri:Area/Ncbi/Checkpoint">009083</idno><idno type="wicri:Area/Main/Merge">000258</idno><idno type="wicri:Area/Main/Curation">000258</idno><idno type="wicri:Area/Main/Exploration">000258</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report</title><author><name sortKey="Zelones, Justin T" sort="Zelones, Justin T" uniqKey="Zelones J" first="Justin T." last="Zelones">Justin T. Zelones</name></author><author><name sortKey="Nigriny, John F" sort="Nigriny, John F" uniqKey="Nigriny J" first="John F." last="Nigriny">John F. Nigriny</name></author></analytic><series><title level="j">Plastic and Reconstructive Surgery Global Open</title><idno type="eISSN">2169-7574</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Pyoderma gangrenosum (PG) is a rare skin disorder of the neutrophilic dermatoses spectrum that can mimic wound infections in surgical patients. PG after breast surgery has been reported but in limited amounts in autologous breast reconstruction patients. We present the first case of PG after a delayed bilateral deep inferior epigastric perforator flap breast reconstruction in the setting of systemic disease along with a systematic review.</p></sec><sec><title>Methods:</title><p>PubMed, Ovid, and Web of Science were systematically searched to obtain cases of PG after autologous breast reconstruction. Sixty articles were identified but only 16 were relevant to this study.</p></sec><sec><title>Results:</title><p>Systemic disease was present in 2 patients (13%). Wound onset occurred typically 5 days after surgery. Fever and/or leukocytosis was observed in 10 patients (63%). Wound cultures were positive in 2 patients (13%). Donor-site wounds were present in 9 patients (56%). Bilateral breast wounds were present in 67% of bilateral cases. Debridement was performed in 10 cases (63%). Skin graft or substitute was performed in 6 cases (38%). Resection of autologous flap was performed in 3 cases (19%). All patients were treated with systemic steroids (81%) and/or immunosuppressive medications (50%). Complete wound healing occurred by 4 months on average.</p></sec><sec><title>Conclusion:</title><p>If early ulcerative wounds develop at multiple sites after autologous breast reconstruction with worsening after debridement and antibiotic therapy, then PG should be considered. It is imperative that an early diagnosis and subsequent treatment with steroids and/or immunosuppressive medications be initiated so further surgical procedures, flap loss, and scarring can be minimized.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Brunsting, La" uniqKey="Brunsting L">LA Brunsting</name></author><author><name sortKey="Goeckerman, Wh" uniqKey="Goeckerman W">WH Goeckerman</name></author><author><name sortKey="O Eary, Pa" uniqKey="O Eary P">PA O’Leary</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Su, Wp" uniqKey="Su W">WP Su</name></author><author><name sortKey="Davis, Md" uniqKey="Davis M">MD Davis</name></author><author><name sortKey="Weenig, Rh" uniqKey="Weenig R">RH Weenig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Powell, Fc" uniqKey="Powell F">FC Powell</name></author><author><name sortKey="Schroeter, Al" uniqKey="Schroeter 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