Pyoderma gangrenosum (PG) is a destructive, necrotizing cutaneous process where surgical debridement can produce 'pathergy' phenomenon. Actually, an accepted strategy is to control the disease medically and follow-up with delayed surgical intervention with a split-thickness skin grafting after prolonged courses of immunosuppressive therapy. We report two cases of pretibial PG, one of them a complicated case of a 23 year-old woman with ulcerative colitis and a huge PG which was successfully treated with a synergistic approach utilizing a sequential protocol with systemic treatment, surgical debridement, antimicrobial silver dressing (Acticoat®), vacuum-assisted closure (VAC) therapy and a double layer of synthetic dermal substitute (Integra®) with a skin graft. A systematic review of the literature displays no previous cases utilizing this combined approach. Rare case reports have described VAC therapy use in the management of PG, and only one has described Integra® use. In both cases, rebuilding of the scaffolding were achieved, there was no evidence of recurrence of PG, the cosmetic results were overall satisfactory without limitation of movement for extension and flexion of the foot.
Level of Evidence: Level V, therapeutic study.
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Conflict of interest
Ashley Novo-Torres, Francisco Javier Céspedes-Guirao, Nozay Guzmán Restituyo, and Elena Lorda-Barraguer declare that they have no conflict of interest.
Patients provided written consent prior their inclusion in the study and use of their images.
For this retrospective study a formal consent from a local ethics committee is not required.
Electronic supplementary material
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Video of flexion and extension with foot propped up on the floor and elevated (Patient 1) (MPG 3224 kb)
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Novo-Torres, A., Céspedes-Guirao, F.J., Guzmán Restituyo, N. et al. Management of pyoderma gangrenosum with combination of systemic treatment, vacuum-assisted closure and synthetic dermal substitute. Eur J Plast Surg 39, 297–302 (2016) doi:10.1007/s00238-015-1147-5
- Pyoderma gangrenosum
- Vacuum-assisted closure
- Silver dressing
- Dermal substitute