Case report: Pyoderma gangrenosum following Deep Inferior Epigastric Perforator (Diep) free flap breast reconstruction

Rajapakse, Y. N.; Bunker, C.B.; Ghattaura, Amar; Jallali, Navid; Henton, J.; James, Simon; Harris, Paul A.; Searle, A.G.

doi:10.1016/j.bjps.2009.10.017

Cited by 23 publications

(8 citation statements)

References 5 publications

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“…PG has occurred in 6 DIEP, 5–10 8 TRAM, 11–18 and 2 LD 19,20 flaps used for breast reconstruction. The average patient age was 51 years (range: 30–73 y).…”

Section: Resultsmentioning

confidence: 99%

“…15 Debridement was performed in 10 cases (63%) with only one of these cases undergoing a single debridement as the only secondary procedure. 5 The majority of patients who underwent debridement required multiple subsequent debridements, but most studies did not quantify the total number of debridements. Patients that underwent debridement without being on steroids or immunosuppressive therapy tended to have wound progression.…”

Section: Resultsmentioning

confidence: 99%

“…A systematic review of the literature has shown the development of PG after 6 deep inferior epigastric perforator (DIEP), 5–10 8 transverse rectus abdominis myocutaneous (TRAM), 11–18 and 2 latissimus dorsi (LD) 19,20 flaps used for autologous breast reconstruction. We present a case of a patient with history of psoriasis and hidradenitis who underwent delayed bilateral DIEP flap breast reconstruction complicated by PG affecting the breast and abdomen.…”

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confidence: 99%

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Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report

Zelones

Nigriny

2017

Plastic and Reconstructive Surgery - Global Open

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Background: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.Methods: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.Results: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.Conclusion: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.

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“…PG has occurred in 6 DIEP, 5–10 8 TRAM, 11–18 and 2 LD 19,20 flaps used for breast reconstruction. The average patient age was 51 years (range: 30–73 y).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report

Zelones

Nigriny

2017

Plastic and Reconstructive Surgery - Global Open

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“…The first case was an immediate reconstruction in the OW group where thrombosis of a long saphenous vein graft used to treat venous congestion was found. The second case was a delayed reconstruction in a patient of the OB group where a healthy flap was removed due to extensive postoperative pyoderma gangrenosum …”

Section: Resultsmentioning

confidence: 99%

Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients

et al. 2015

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“…According to our systematic review, few cases have a good evolution with the use of NPWT before starting immunosuppressive therapy or without association with immunosuppressive therapy. 8,15,[20][21][22][23][24][25][26][27] On the other hand, the absence of wound improvement after using the NPWT has also been described in the literature (Table 2). In most cases, this outcome occurred when NPWT was performed without association with systemic immunosuppressive therapy, which increases the likelihood of active disease, with an exacerbated inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

Almeida

Coltro

Gonçalves

et al. 2021

Wound Repair Regeneration

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Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according

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Case report: Pyoderma gangrenosum following Deep Inferior Epigastric Perforator (Diep) free flap breast reconstruction

Cited by 23 publications

References 5 publications

Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report

Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report

Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients

The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

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