Perioperative management of pyoderma gangrenosum

Haag, Carter; Bacik, Lindsay; Latour, Emile; Morse, Daniel C; Fett, Nicole; Ortega‐Loayza, Alex G.

doi:10.1016/j.jaad.2020.01.002

Cited by 17 publications

(16 citation statements)

References 13 publications

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“…There is, however, a population of patients with noninflammatory PG ulcers refractory to immunosuppressive treatment who have responded favorably to surgical intervention. One study looked at 126 cases of PG which were treated with operative management and found that only 16.7% had disease progression post-operatively [42]. Additionally, there is recent literature outlining the use of surgical therapy in conjunction with immunosuppression, negative pressure wound therapy and skin grafting to treat PG lesions.…”

Section: Treatmentmentioning

confidence: 99%

Pyoderma Gangrenosum: A Review of Updates in Diagnosis, Pathophysiology and Management

Skopis

Bag-Ozbek

2021

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Pyoderma gangrenosum (PG) is a rare entity that is characterized by infiltration of neutrophils into the dermis, causing the formation of rapidly enlarging, painful and necrotic skin ulcers. The pathophysiology of PG is still poorly understood. However, genetic, autoimmune and autoinflammatory mechanisms have been proposed that could potentially explain the etiology of this ulcerating skin disorder. Early diagnosis and treatment are key, as the disease course is rapidly progressive and can leave disfiguring, cribriform scars. However, the diagnosis of PG proves difficult, firstly because there are multiple variants of the disease and secondly because it is a clinical diagnosis and can appear similar to that of other diseases such as vasculitis, skin/soft tissue infections and malignancy. Additionally, there are no official diagnostic criteria to aid in the recognition of PG, which often leads to significant delays in diagnosis. The treatment of PG consists in immunosuppression. However, due to a lack of standardized guidelines, therapeutic regimens are usually dependent upon the individual clinician’s experience and are based on little evidence. Knowledge of the clinical features and pathophysiology of PG can aid in early diagnosis and targeted treatment strategies, which in turn results in improved patient outcomes.

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Section: Treatmentmentioning

confidence: 99%

Pyoderma Gangrenosum: A Review of Updates in Diagnosis, Pathophysiology and Management

Skopis

Bag-Ozbek

2021

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“…Surgical intervention is decided on a case-by-case basis and may be beneficial in a subgroup of patients with persistent noninflammatory ulcers. 4 Our patient had an unusual presentation of PG in the scrotum that resulted in scrotal prolapse and exposure of the testicle, likely worsened by his CHF exacerbation and poor wound healing from diabetes. Surgical intervention was deferred in favor of performing loose wound edge approximation in office.…”

Section: Discussionmentioning

confidence: 80%

“…Currently, there is no consensus on the most effective perioperative treatments for patients with PG undergoing surgical procedures. 4 …”

Section: Discussionmentioning

confidence: 99%

Loose scrotal wound edge approximation in the setting of pyoderma gangrenosum after COVID-19 infection

Hasan

Kim

Clark

2022

Urology Case Reports

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Pyoderma gangrenosum (PG) is a rare autoinflammatory skin disease characterized by recurrent ulcers. It is a diagnosis of exclusion and treatment can be challenging due to limited evidence-based therapies. While surgical management is typically avoided due to the risk of pathergy, it can be warranted in specific cases. Here, we have illustrated a unique case of genital PG that began after COVID-19 infection and which resulted in scrotal prolapse with testicular exposure. Loose closure with a horizontal mattress suture while the patient was on immunosuppression allowed for complete wound healing.

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“…Even with early diagnosis and treatment, patients with PG may have a protracted wound healing course. No single regimen has been identified as superior in the treatment of PG, but most successful treatment regimens and perioperative prophylaxis include corticosteroids, cyclosporine, or a combination of both [ 6 ]. In the absence of PG improvement with these medications, other immunomodulatory agents (e.g., monoclonal antibodies) can be considered [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Post-breast Reduction Pyoderma Gangrenosum Managed With Gender-Affirming Top Surgery

Peoples¹,

Pestana²

2021

Cureus

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Pyoderma gangrenosum (PG) is a rare skin condition characterized by ulcerative lesions and most often associated with inflammatory bowel diseases (IBDs), ulcerative colitis, or Chron's disease. Postsurgical pyoderma gangrenosum (PSPG) of the breast is exceptionally rare and can occur in the absence of IBD. We report on a patient with pyoderma gangrenosum following elective breast reduction and subsequent reconstruction with gender-affirming top surgery. Through discussion of this IRB-reviewed case, we encourage reconstructive surgeons to incorporate understanding of a patient's gender identity, expression, or goals during treatment to optimize their patient-centered care.

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Perioperative management of pyoderma gangrenosum

Cited by 17 publications

References 13 publications

Pyoderma Gangrenosum: A Review of Updates in Diagnosis, Pathophysiology and Management

Pyoderma Gangrenosum: A Review of Updates in Diagnosis, Pathophysiology and Management

Loose scrotal wound edge approximation in the setting of pyoderma gangrenosum after COVID-19 infection

Post-breast Reduction Pyoderma Gangrenosum Managed With Gender-Affirming Top Surgery

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