Management of an unfortunate triad after breast reconstruction: Pyoderma gangrenosum, full-thickness chest wall defect and Acinetobacter Baumannii Infection

Schintler, Michael; Grohmann, Martin; Donia, Claudio; Aberer, Elisabeth; Scharnagl, E.

doi:10.1016/j.bjps.2009.12.013

Cited by 36 publications

(21 citation statements)

References 10 publications

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“…All wound cultures were negative except for 2 cases (13%), which grew out methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii . 6,12 There were 3 cases (19%) that had a history of previous breast infection before their autologous breast reconstruction, but none of these patients developed a subsequent breast infection. 11,14,15 …”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

“…Resection of the autologous breast flap occurred in 3 cases (19%), which included 1 DIEP and 2 TRAM flaps. The loss of these flaps was secondary to arterial thrombosis, 8 repeated radical debridements, 12 and to remove a potential source of sepsis. 16 The diagnosis of PG in these cases occurred after resection of the flaps.…”

Section: Resultsmentioning

confidence: 99%

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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“…In 25 of these cases PG occurred post breast surgery, predominantly breast reduction mammoplasty. [7][8][11][12][13][14]16,[18][19][21][22][23][24][25][26][27][28][29][30][31][32] 16 out of 32 cases described in the literature have been associated with conditions such as inflammatory bowel disease, rhematoid arthritis and breast malignancy but there are also cases with no pre-existing disease. [6][7][8][10][11][12]17,23,[25][26]28,[30][31] The age of presentation for PG is variable and ranges from 15 to 66 years old.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…28,30,32 Vaccuum assisted closures and hyperbaric oxygen were used in 4 cases. 14,[29][30]32 A useful observation made by us was that 5 out of the 32 cases in the current literature also underwent breast debridement upon initial presentation, as the diagnosis of PG was not initially considered. 6,9,17,19,32 This is likely due to lack of association of this rare condition and also because PG is hard to clinically distinguish from infective ulcers, which if left untreated can have a fatal outcome.…”

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Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin

Sinnya¹,

Hamza²

2013

J Dermatol Case Rep

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Background: Pyoderma gangrenosum is a rare neutrophilic dermatosis which leads to necrotic and painful skin ulceration. PG of the breast is extremely rare with 32 documented cases in the current literature. Delay in diagnosis worsens scarring as the ulcers are rapidly expanding, painful and usually slow to heal. Case presentation:We present a case of pyoderma gangrenosum of the breast in a patient with associated rheumatoid arthritis which was initially diagnosed as an infected breast ulcer and later successfully treated with systemic steroids and intravenous immunoglobulin (IVIG). Conclusion:Even though PG of the breast has been gaining increased recognition over the past two decades, this has been more common in the post-surgical setting. This case highlights the need to consider PG as a differential diagnosis when faced with unsual cases of breast ulceration and the importance of multidisplinary approach for effective treatment of this condition. (J Dermatol Case Rep. 2013; 7(2): 64-68)

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The Role of Negative Pressure Wound Therapy for Salvaging Implant-Based Breast Reconstruction

Goltsman

Cheong

Posner

et al. 2018

Plastic and Thoracic Surgery, Orthopedics and Ophthalmology

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Management of an unfortunate triad after breast reconstruction: Pyoderma gangrenosum, full-thickness chest wall defect and Acinetobacter Baumannii Infection

Cited by 36 publications

References 10 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

Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin

The Role of Negative Pressure Wound Therapy for Salvaging Implant-Based Breast Reconstruction

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