Pyoderma Gangrenosum after Breast Cancer Resection: A Less-invasive and Early Treatment Using the Skin around Ulcers

Abstract

Summary: Surgical invasion is a risk factor of pyoderma gangrenosum (PG). A total of 25% of postoperative PG cases were reported to occur after breast surgeries, including bilateral breast reduction and breast reconstruction following cancer resection. Immunosuppressive therapy and less-invasive wound therapy are necessary; however, the complete healing of ulcers takes 5.1 months on average. We herein report a case of skin grafting under a surgical concept of less-invasive and short-term treatment. An 82-year-old woman complained of a high fever and severe pain at her breast wounds after bilateral breast cancer resection. Although we performed emergency debridement surgery to remove the necrotic tissue, suspecting surgical site infection and inflammation, her high fever persisted. She was diagnosed with PG because of the physical findings of characteristic painful, sterile ulcerations, bullae and pustules, and the pathological abundance of neutrophils in the absence of infection and vasculitis. Oral administration of prednisolone 30 mg/day improved the symptoms, and we applied negative-pressure wound therapy (NPWT) from day 16 following debridement surgery. After the gradual reduction of oral steroid intake to 12.5 mg/day, we performed skin grafting surgery. To limit the surgical invasion, we used the surplus skin around the ulcers. Split-thickness mesh skin grafts were fixed by NPWT to avoid the use of tie-over sutures. We achieved short-term treatment of PG with a less-invasive surgical strategy using skin around the ulcers and NPWT.

Treatment of Pediatric Pyoderma Gangrenosum With Modified Negative Pressure Wound Therapy and Intralesional Corticosteroids

“…As previously stated, subatmospheric pressure therapy increases tissue perfusion and granulation tissue formation while decreasing the bacterial load and interstitial edema 8. Case studies suggest that NPWT with systemic corticosteroids may be effective for PG 13,14. Additionally, Pichler and colleagues15 reported improvement of PG in 13 of 15 patients who received NPWT with split-thickness skin grafts, with complete resolution in 9 patients.…”

“…8 Case studies suggest that NPWT with systemic corticosteroids may be effective for PG. 13,14 Additionally, Pichler and colleagues 15 reported improvement of PG in 13 of 15 patients who received NPWT with split-thickness skin grafts, with complete resolution in 9 patients. Another case study reported healing of refractory PG with NPWT and intravenous immunoglobulin (IVIg).…”