Reconstructive microsurgical approach for the treatment of pyoderma gangrenosum

“Pyoderma gangrenosum of the breast: A challenging diagnosis”

“…This common mistake often leads to antibiotic therapy and unnecessary debridement which may even be harmful and worsen the condition. 3,[6][7][8][9] In fact, our mean time from clinical presentation to correct diagnosis was 10.67 months but, in the literature, 3-year diagnosis delay has been reported. 8 Ehrl et al 8 state that unsuccessful first-line treatment is given for an average of 20 days before an accurate diagnosis is made, and Duval et al suggest a diagnostic index for atypical breast ulceration which worsens after 48 hours of wide-spectrum antibiotics.…”

“…Second-line treatments are less frequently used and include: topical or intralesional corticosteroids, intravenous immunoglobulin, dapsone, biologic therapies (anti-TNF-alpha agents), mycophenolate mofetil or tacrolimus. 1,4,6,8,9 Once corticotherapy is started, a rapid response is described with marked improvement in wound and patient status within the first 24-48 hours. 3,6,8 Re-epithelization often starts from the margins and the ulceration heals with a cribriform pigmented scar after weeks to months of immunosuppressive therapy.…”

“…7,8 On the other hand, if a surgical procedure is indispensable, it should always be carried out under immunosuppressive therapy and during disease remission. 1,[6][7][8][9] Gentle debridement restricted to the necrotic tissue, vacuum-assisted devices, direct closures, and split skin thickness grafts may be helpful in reducing wound morbidity, speeding up healing, and achieving a better esthetic outcome. 4 It is important to emphasize that for the prevention of PG in future surgery, prophylactic perioperative steroid or immunomodulator therapy are advocated, tapering them over 6-12 months.…”

“…2,[6][7][8][9] The pathergy phenomenon, the appearance of new lesions after minor trauma, is classically described in PG. 9 While it typically involves the lower limbs, PG has been described in the breast, sometimes as a complication after a surgical procedure or without any clear injury or associated condition, making a definitive diagnosis more difficult. 1,[5][6][7] Unfortunately, diagnosis is even more problematic because there is no specific diagnostic test or pathognomonic clinical feature, meaning that PG is often confused with other causes of ulceration or infection while the condition progresses.…”

Absence of donor‐site pathergy following fractional autologous full‐thickness skin grafting in pyoderma gangrenosum

“…Split‐thickness skin grafts (STSGs) may also be performed; however, as it is a procedure comprising a deeper cleavage, the concern of pathergy at the donor site may be greater in comparison with ESGs. More recently, some experience suggested that if the STSG is carried out accompanied by adequate immunosuppression this will lead to improved healing of ulcers with PG . Pichler et al .…”