The role of negative pressure wound therapy (<scp>NPWT</scp>) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

Almeida, Ivan R; Coltro, Pedro Soler; Gonçalves, Henrique Ovidio Coraspe; Westin, Andrezza Telles; Almeida, Juliano Baron; Lima, Renan Victor Kümpel Schmidt; Silva, Marcelo F.; Farina, Jayme Adriano

doi:10.1111/wrr.12910

Cited by 15 publications

(19 citation statements)

References 72 publications

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“…We used surplus skin around the ulcers to avoid the risk of creating further ulcers, such as in the abdominal and inguinal areas. Evidence supporting the utility of NPWT for PG is accumulating, 3,6,7 and Eisendle et al insisted that the best surgical approach is a split-thickness skin graft fixed with NPWT. 8 We also performed NPWT for the preoperative wound bed preparation and postoperative skin graft fixation.…”

Section: Discussionmentioning

confidence: 99%

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

Hirai

Tsuge

Usui

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hirai

Tsuge

Usui

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Another option to consider would have been negative pressure wound therapy in combination with the above systemic anti-inflammatory and immunosuppressive therapies. 4 Over the course of treatment, excess fibrin deposition from inadequate debridement was the predominant factor hindering re-epithelialization. [49][50][51] In PG, avoidance of overzealous debridement is recommended due to the risk of pathergy.…”

Section: Discussionmentioning

confidence: 99%

“…1 The management of PG is challenging, as there is no management guideline based on clinical evidence or expert consensus. 3,4 Topical and/or systemic medical therapy, analgesia, compression, and diligent wound care are indicated. 1 Otherwise, treatment aims to minimize systemic inflammation, as the pathophysiology of PG-while multifactorial and poorly understood 1,5 is thought to involve inflammatory cytokines and signaling cascades including interleukin (IL)-23 and T-helper (Th)17 cell recruitment.…”

Section: Introductionmentioning

confidence: 99%

Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report

Leow¹,

Zubrzycki²

2022

CCID

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Elevated levels of inflammatory mediators-including the interleukin IL-23-are implicated in the pathogenesis of pyoderma gangrenosum (PG), an autoinflammatory neutrophilic dermatosis characterized by rapidly enlarging, suppurative ulcers and cribriform scarring. Here, we present the first case report of significant response of isolated ulcerative PG with tildrakizumab, a biologic agent directed against the p19 subunit of IL-23, in an elderly woman with extensive treatment-refractory PG on her left leg. Tildrakizumab (100 mg subcutaneously at weeks 0 and 4, then every 8 weeks, and eventually increased in frequency to every 6 weeks), combined with acetic acid soaks each morning and chemical debridement every evening with 3% hydrogen peroxide, resulted in progressive decrease in ulcer size and depth, re-epithelialization, and recovery of sensory perception. This report describes the dramatic clinical response of ulcerative PG on the leg with tildrakizumab.

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“…In complex cases of PG, a multimodality approach of adjunctive wound vac therapy in combination with immunosuppression has yielded positive results for difficult-to-heal PG ulcers [2][3][4][5][6][7]. Due to concerns of pathergy, it is recommended that NPWT for PG be applied in the setting of adequate immunosuppression [8].…”

Section: Discussionmentioning

confidence: 99%

“…Due to concerns of pathergy, it is recommended that NPWT for PG be applied in the setting of adequate immunosuppression [ 8 ]. Traditional NPWT on PG has been well studied [ 5 ]; however, experience with the newer advanced technology of NPWTi-d on PG is limited. The newer technique of NPWTi-d which combines NPWT with instillation-and-dwelling of an irrigating solution over the wound environment has shown promising results for PG wounds complicated by infections [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Non-surgical Management of Complex Refractory Pyoderma Gangrenosum With Negative Pressure Wound Therapy With Instillation

Lee¹,

Song²,

Wallace³

et al. 2021

Cureus

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Pyoderma gangrenosum (PG) is a rare skin disorder primarily treated with immunosuppression medication. We report a case of a large, chronic PG wound treated with adjunct negative pressure wound therapy with instillation and dwell time (NPWTi-d) using nonadherent dressing (Mepitel) and reticular open-cell foam with through holes (ROCF-CC) with positive outcomes. The patient was a 62-year-old female with rheumatoid arthritis, Hashimoto's thyroiditis, lymphedema, and morbid obesity who presented with a 19.5 cm x 13.2 cm x 2.1 cm wound of three years duration on the right posterolateral lower extremity that successfully responded to a multimodality approach of immunosuppression and wound vac therapy. We conclude in our case that NPWTi-d with Mepitel and ROCF-CC enhanced the wound healing process, and we discuss NPWTi-d's potential role and benefit as an adjunctive therapy option for chronic and poorly controlled PG on patients taking concurrent immunosuppression.

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The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

Cited by 15 publications

References 72 publications

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

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

Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report

Non-surgical Management of Complex Refractory Pyoderma Gangrenosum With Negative Pressure Wound Therapy With Instillation

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