Pyoderma gangraenosum as rare complication of incisional hernia repair in a patient with Werlhof’s disease

Strauß, Arne; Storim, J.; Germer, Christoph‐Thomas; Dietz, Ulrich; Wildenauer, René

doi:10.1007/s10029-010-0712-x

Cited by 9 publications

(2 citation statements)

References 11 publications

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“…24 ITPs and SLEs accompany wound impairment of sudden onset and may prolong the symptoms 26,27 and even a pyoderma gangrenosum is associated with an incisional wound of hernia in a patient of ITP. 28…”

Section: Characteristics Of Idiopathic Thrombcytopenic Purpura and Symentioning

confidence: 99%

Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus

Akita

2015

The International Journal of Lower Extremity Wounds

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Infections in lower extremities are sometimes concerned with systemic immunological disorders such as idiopathic thrombocytopenic purpura and systemic lupus erythematosus, which are treated with systemic steroids. Steroid therapy impairs the epithelial wound healing and with systemic condition, especially with systemic lupus erythematosus, the wound is susceptible for infection. Even a pyoderma gangrenosum sometimes occurs in a patient with idiopathic thrombocytopenic purpura with an incisional wound of hernia. The severe signs and symptoms are the deep skin and soft tissue infections, mainly caused by group A streptococcus, composed of necrotizing fasciitis and muscle necrosis. Medically suspected necrotizing fasciitis patients should be empirically and immediately administered with broad-spectrum antibiotics, which may cover the common suspected pathogens. In type I (polymicrobial) infection, the selection of antimicrobial should be based on medical history and Gram staining and culture. The coverage against anaerobes is important in type I infection. Metronidazole, clindamycin, or beta-lactams with beta-lactamase inhibitor or carbapenems are the treatment of choice against anaerobes, while early surgical debridement-wide enough and deep enough-is the core treatment of necrotizing fasciitis and results in significantly better mortality compared with those who underwent surgery after a few hours of delay. When necrotizing fasciitis is considered and the patient is brought to the operation room, aggressive and extensive surgical debridement is explored. Tissue involved should be completely removed until no further evidence of infection is seen. When further debridement is required, the patient must return to the operating room immediately. In this context, the temporal coverage using the artificial dermis after debridement is useful because there is no loss of the patient's own tissue and yet it is easier for "second-look" surgery or secondary reconstruction, and extensive enough debridement is always the mainstay of the therapy.

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Section: Characteristics Of Idiopathic Thrombcytopenic Purpura and Symentioning

confidence: 99%

Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus

Akita

2015

The International Journal of Lower Extremity Wounds

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“…Literature provides only occasional case reports of PG after mesh implantation, where the diagnosis is frequently missed or, at best, made with significant delay [3][4][5][6].…”

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confidence: 99%

Pyoderma gangrenosum after ventral hernia repair: a pitfall and how to avoid it

et al. 2013

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306 Pyoderma gangrenosum after ventral hernia repair: a pitfall and how to avoid it 1 3 SummaryBackground In case of large ventral hernias, the avoidance of a mesh infection caused by a surgical site infection (SSI) is crucial, as surgical options are limited. Pyoderma gangrenosum (PG) is a rare condition that mimics SSI, and is therefore often identified with significant delay. Mechanical alteration is known to maintain the progress of PG, outlining the importance of early discrimination against SSI.Methods We report our recent clinical experience with PG in a 73-year-old patient after ventral hernia repair.Results We present our experience, based on the case of a 73-year-old woman with postoperative PG.Conclusions By a systematic approach, we provide indicators to contribute to an earlier diagnosis and adequate treatment in future cases. To the best of our knowledge, this is the first to-the-point checklist in the published literature so far.

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Therapie der Netz(-Implantat)-Infektion

Dietz

Spor

Germer

2011

Chirurg

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Infections of an implanted hernia mesh are a major challenge. The incidence of mesh infections after incisional hernia repair is about 1% for endoscopic techniques and can be more than 15% in open techniques. Intraoperative mesh contamination is considered to be the primary cause. All woven or knitted hernia meshes have recesses where bacteria may adhere and establish colonies. The bacterial spectrum for mesh infection includes skin pathogens, such as Staphylococcus aureus (including MRSA), Streptococcus spp., as well as E. coli, Enterococcus and Mycobacteria. The therapy approach needs to be tailored to the morphological findings and the treatment for uncomplicated phlegmon is broad spectrum antibiotic therapy. If there is encapsulated fluid accumulation, CT-controlled drainage and daily infusion of antiseptics via the drain is a good option. For dermal necrosis, mesh fistula, exposed mesh or enterocutaneous fistula, a precise CT evaluation is necessary to tailor the operation. Vacuum systems are gaining increased acceptance in conditioning the local findings. For most patients the therapeutic concept will be based on individual decisions. If parts of a formerly infected mesh remain in the patient, a lifelong follow-up is necessary.

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Pyoderma gangraenosum as rare complication of incisional hernia repair in a patient with Werlhof’s disease

Cited by 9 publications

References 11 publications

Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus

Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus

Pyoderma gangrenosum after ventral hernia repair: a pitfall and how to avoid it

Therapie der Netz(-Implantat)-Infektion

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