Managing Ulcers Associated with Pyoderma Gangrenosum with a Urinary Bladder Matrix and Negative-Pressure Wound Therapy

Abstract

Pyoderma gangrenosum (PG) is a rare disease that presents as painful ulcerations with inflammation and undermining at the borders. The ulcers can occur anywhere on the body but are most commonly seen on the lower extremities. The etiology of PG is unknown, and there are no definitive diagnostic criteria; PG is a diagnosis of exclusion, which can present serious delays in treatment. Patients should be treated with an interdisciplinary approach with aggressive immunosuppression, treatment of any comorbidities, maximization of nutrition status, reconstructive surgery for treatment of the wound, and physical therapy for deconditioning. This article presents a case study of one patient treated with a porcine urinary bladder matrix and negative-pressure wound therapy; this treatment combination provided pain relief, coverage of the wound, an acceptable aesthetic outcome, and long-term stability.

Case Report of Two Patients With COVID-19 and Sacral Pressure Injuries Associated with Pyoderma Gangrenosum

“…22 The borders are undermined, and the base has a combination of necrotic and mucopurulent tissue. 23 There is no single, specific laboratory test that can provide a definitive diagnosis of PG. Further, histologic findings are often nonspecific and depend on the stage of the disease.…”

“…Characteristically, the lesion spreads fast, at a rate of up to 2 cm daily, with central necrosis appearing within 24 to 72 hours 22 . The borders are undermined, and the base has a combination of necrotic and mucopurulent tissue 23 …”

Characterizing the inherent activity of urinary bladder matrix for adhesion, migration, and activation of fibroblasts as compared with collagen-based synthetic scaffold

“…5 Notwithstanding, some naturally-derived ECM scaffolds show intriguing enhanced bioactivity for ISTR. Although clinical randomized controlled studies are lacking, there are still many case reports 6,7 and animal experiments 8,9 that suggest the inherent pro-regenerative activity of natural ECM scaffolds.…”

Pyoderma gangrenosum in a patient with Down syndrome

“…Leczenie miejscowe stanowi uzupełnienie ogólnego i obejmuje stosowanie takrolimusu, bardzo silnych GKS (także w postaci iniekcji w nacieczone brzegi zmian), specjalistycznych opatrunków i terapię podciśnieniową [31][32][33]. Należy dbać o odpowiednie nawilżenie i zapobiegać nadkażeniom bakteryjnym rany.…”