Pyoderma gangrenosum: a new complication after groin exposure for attempted endovascular aortic stent-graft placement

Gassman, Andrew; Sinno, Sammy; Milner, Ross; Gamelli, Richard L.

doi:10.1258/vasc.2011.cr0263

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…8,19,74 Another common comorbidity was rheumatoid 75 /unspecified 48,69 arthritis or positive rheumatoid factor. 76 Other concomitant pathologies with immune dysfunction were antiphospholipid antibody syndrome, idiopathic thrombocytopenic purpura, myelofibrosis, 34 acute/chronic renal failure, 34,75 factor XIII deficiency, 48 platelet dysfunction, 48 and hypothyroidism. 77 Other considerable comorbidities were cancers (breast, skin, lymphoma) and a history of abortions.…”

Section: Resultsmentioning

confidence: 99%

Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review

Guliyeva,

Janis

2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: “pyoderma gangrenosum” and “surgery.” This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.

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Section: Resultsmentioning

confidence: 99%

Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review

Guliyeva,

Janis

2024

Plastic and Reconstructive Surgery - Global Open

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“…Surgery alone represents a potential risk, since the inflammatory response in the surgical wound it can act as a trigger for PG (pathergy phenomenon). 155-157 For this reason, any unavoidable surgical procedure should be done as adjunctive to immunosuppression only in patients with stable disease or partial remission. Autologous split-skin grafts have been used with variable outcomes.…”

Section: Methodsmentioning

confidence: 99%

Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One

Vallini

Andreini

Bonadio

2017

The International Journal of Lower Extremity Wounds

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Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease, characterized by recurrent skin ulcers, which in almost 50% of cases are associated with systemic autoimmune disorders, including rheumatoid arthritis, chronic hepatitis, inflammatory bowel disease, paraproteinemias and hematological malignancies. A systematic search of literature for PG was carried out using the PubMed, Embase, and Google Scholar databases for the purpose of this review and 2780 articles were retrieved up to February 2017. Inflammation represents the predominant aspect of the disease, but its pathophysiological mechanisms are not completely clear yet, since there are many studies showing only one or more isolated findings of the disease. The goal of PG treatment is to reduce inflammation in order to promote ulcer healing by minimizing side effects of therapy. Several systemic and local treatments are available, but the lack of large randomized double-blind studies results in an absence of a uniform therapeutic standard: thus, more clinical studies are required in order to make head-to-head comparisons between combination and single-drug therapies and to identify specific combination therapies for distinctive clinical patterns of PG.

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“…41 In the current era of emerging endovascular procedures, it must also be noted that even a transcatheter approach may not facilitate complete avoidance of pyoderma gangrenosum, as such a case has already been demonstrated. 43 Summing up, pyoderma gangrenosum is a rare condition that is triggered by surgical procedures or even skin puncture. Following cardiac surgery, pyoderma gangrenosum can mimic an infection of the sternotomy site and even a mediastinitis.…”

Section: Treatment Of Pyoderma Gangrenosummentioning

confidence: 99%

Pyoderma Gangrenosum after Cardiac Surgery

Petrov¹,

Kappert²,

Schmidt

et al. 2021

Thorac Cardiovasc Surg

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Background Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection. Methods A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided. Results A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries. Conclusion Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis—the typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment.

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Pyoderma gangrenosum: a new complication after groin exposure for attempted endovascular aortic stent-graft placement

Cited by 4 publications

References 27 publications

Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review

Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review

Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One

Pyoderma Gangrenosum after Cardiac Surgery

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