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International Orthopaedics

, Volume 42, Issue 2, pp 239–245 | Cite as

Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature

  • Stephan Ebrad
  • Mathieu SeverynsEmail author
  • Ahmed Benzakour
  • Benoit Roze
  • Christian Derancourt
  • Guillaume-Anthony Odri
  • Jean-Louis Rouvillain
Review Article

Abstract

Introduction

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by a painful ulceration mimicking infection of the operative site. To this day, there is still no general agreement on the medical and surgical treatment of PG. This systematic review of the literature aims to summarise recent studies about post-operative PG in orthopaedic surgery to improve its medical and surgical management.

Method

In April 2017, we carried out an exhaustive review of the literature in MEDLINE, PubMed and Cochrane databases. Key words were pyoderma gangrenosum, orthopaedic surgery, and surgical wound infection. We identified 183 articles. After excluding articles reporting idiopathic PG, cases secondary to non-orthopaedic surgery, and cases about other subtypes of dermatosis, 30 studies were identified. We only included articles reporting PG after orthopaedic or trauma surgery.

Results

Thirty-one cases of PG have been reported, 58% (18) of which were in women, whose mean age was 56.5 years. Clinical signs were constant, the most frequently affected site was lower limbs [77.4% (24)] and delay of symptom onset was two to 17 days. Systemic corticosteroid therapy was systematic, polyvalent immunoglobulins were used in two cases and immunosuppressive drugs in one. Negative pressure therapy was used in seven cases and hyperbaric oxygen in three.

Discussion

Delayed diagnosis leads to one or more surgical revisions, which could have been avoided by using early and adapted medical treatment. Early onset of a painful and infected ulcer at the operating site in a patient at risk of PG is an indicator that dermatologist advice is recommended before surgical debridement. Surgical revision, outside the inflammatory phase and/or covered by a systemic corticosteroid therapy, does not lead to PG relapse.

Level of evidence

IV: Systematic revue of the literature.

Keywords

Pyoderma gangrenosum Surgical-site infection Surgical wound 

Notes

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Orthopaedic and Traumatologic DepartmentMilitary Hospital Robert PicquéVillenave d’OrnonFrance
  2. 2.Orthopaedic and Traumatologic DepartmentLa Meynard University HospitalFort-de-FranceMartinique
  3. 3.Department of InfectiologyLa Meynard University HospitalFort-de-FranceMartinique
  4. 4.Department of DermatologyLa Meynard University HospitalFort-de-FranceMartinique
  5. 5.Orthopaedic and Traumatologic DepartmentLariboisière University HospitalParisFrance

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