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Postsurgical Pyoderma Gangrenosum After Breast Surgery: A Plea for Early Suspicion, Diagnosis, and Treatment

  • Case Report
  • Breast Surgery
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Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder. Although PG is a diagnosis of exclusion, prompt recognition is essential to attain the desired outcomes. From an aesthetic standpoint, this is especially critical with breast involvement and other body segments. We present a consecutive case series of four patients who developed PG following breast surgery and responded to early intervention.

Methods

A chart review identified four patients who were identified as having developed PG after either aesthetic or reconstructive breast surgery. Their histories, associated risk factors, diagnosis, course of treatment, and results were documented. The PubMed database was then searched to find the literature for comparison.

Results

The average time from surgery to the onset of symptoms was 11 days, and the average time from the onset of symptoms to the correct diagnosis of PG was 41 days. The average length of steroid therapy was 25 days. The average time from the initiation of steroids to complete wound closure was 51 days. The average time from the onset of symptoms to complete wound closure bilaterally was 87 days. All wounds healed with conservative management.

Conclusion

Postsurgical PG is a rare but recognized cause of postoperative wound breakdown in patients who have undergone plastic surgery procedures to the breast. Early recognition and treatment can facilitate prompt reversal of the inflammatory process leading to complete wound healing and limitation of the morbidity that can be associated with the disease.

Level of Evidence V

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References

  1. Papilion JD, Bergfield TG (1990) Pyoderma gangrenosum complicating infection of the hand a case report and review of the literature. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-199005000-00022

    Article  PubMed  Google Scholar 

  2. Zelones JT, Nigriny JF (2017) Pyoderma gangrenosum after deep inferior epigastric perforator breast reconstruction: systematic review and case report. Plast Reconstr Surg Global Open. https://doi.org/10.1097/GOX.0000000000001239

    Article  Google Scholar 

  3. Patel F, Fitzmaurice S, Duong C et al (2015) Effective strategies for the management of pyoderma gangrenosum: a comprehensive review. Acta Dermato Venereol. https://doi.org/10.2340/00015555-2008

    Article  Google Scholar 

  4. Ehrl DC, Heidekrueger PI, Broer PN (2018) Pyoderma gangrenosum after breast surgery: a systematic review. J Plast Reconstr Aesthetic Surg. https://doi.org/10.1016/j.bjps.2018.03.013

    Article  Google Scholar 

  5. Tuffaha SH, Sarhane KA, Mundinger GS et al (2016) Pyoderma gangrenosum after breast surgery: diagnostic pearls and treatment recommendations based on a systematic literature review. Ann Plast Surg. https://doi.org/10.1097/SAP.0000000000000248

    Article  PubMed  Google Scholar 

  6. Lemos AC, Aveiro D, Santos N, Marques V, Pinheiro LF (2017) Pyoderma gangrenosum: an uncommon case report and review of the literature. Wounds 29(9):E61–E69

    PubMed  Google Scholar 

  7. Rand RP, Brown GL, Bostwick J (1988) Pyoderma gangrenosum and progressive cutaneous ulceration. Ann Plast Surg. https://doi.org/10.1097/00000637-198803000-00019

    Article  PubMed  Google Scholar 

  8. Wustrack KO, Zarem HA (1978) Pyoderma Gangrenosum. Plast Reconstr Surg. https://doi.org/10.1097/00006534-197809000-00014

    Article  PubMed  Google Scholar 

  9. Larcher L, Schwaiger K, Eisendle K et al (2015) Aesthetic breast augmentation mastopexy followed by post-surgical pyoderma gangrenosum (PSPG): clinic, treatment, and review of the literature. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-015-0499-3

    Article  PubMed  Google Scholar 

  10. Simon AM, Khuthaila D, Hammond DC, Andres A (2006) Pyoderma gangrenosum following reduction mammaplasty. Can J Plast Surg 14(1):37–40

    Article  Google Scholar 

  11. Zuo KJ, Fung E, Tredget EE, Lin AN (2014) A systematic review of post-surgical pyoderma gangrenosum: identification of risk factors and proposed management strategy. J Plast Reconstr Aesthetic Surg. https://doi.org/10.1016/j.bjps.2014.12.036

    Article  Google Scholar 

  12. Pichler M, Larcher L, Holzer M et al (2016) Surgical treatment of pyoderma gangrenosum with negative pressure wound therapy and split thickness skin grafting under adequate immunosuppression is a valuable treatment option: case series of 15 patients. J Am Acad Dermatol. https://doi.org/10.1016/j.jaad.2015.09.009

    Article  PubMed  Google Scholar 

  13. Canzoneri C, Taylor D, Freet D (2018) Is prophylactic immunosuppressive therapy for patients with a history of postsurgical pyoderma gangrenosum necessary? J Cutaneous Aesthetic Surg 11(4):234. https://doi.org/10.4103/jcas.jcas_98_17

    Article  Google Scholar 

  14. Touil LL, Gurusinghe DA, Sadri A, El-Gawad A, Fahmy FS (2017) Postsurgical pyoderma gangrenosum versus necrotizing fasciitis. Ann Plast Surg 78(5):582–586. https://doi.org/10.1097/sap.0000000000001070

    Article  CAS  PubMed  Google Scholar 

  15. Fria Ancona G, Hierro Orozco S (1998) Neutrophilic dermatosis. Rev Alerg Mex. https://doi.org/10.2165/11310730-000000000-00000

    Article  PubMed  Google Scholar 

  16. Ormerod AD, Thomas KS, Craig FE, Mitchell E, Greenlaw N, Norrie J, Williams HC (2015) Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial. BMJ. https://doi.org/10.1136/bmj.h2958

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vilches FS, Vera-Kellet C (2017) Pyoderma gangrenosum: classic and emerging therapies. Med Clín (Engl Ed) 149(6):256–260. https://doi.org/10.1016/j.medcle.2017.08.007

    Article  Google Scholar 

  18. Sheldon DG, Sawchuk LL, Kozarek R (2000) Twenty cases of peristomal pyoderma gangrenosum. Arch Surg 135(5):564. https://doi.org/10.1001/archsurg.135.5.564

    Article  CAS  PubMed  Google Scholar 

  19. Apalla Z, Lallas A, Karteridou A, Sotiriou E, Papaioannou K, Chaidemenos G (2012) Pyoderma gangrenosum complicating mammaplasty. Int Wound J. https://doi.org/10.1111/j.1742-481X.2011.00916.x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Spectrum Health/Michigan State University Plastic Surgery Residency, Partners in Plastic Surgery, 4070 Lake Dr., Suite 202, Grand Rapids, MI, 49546, USA

    Dennis Hammond

  2. Partners in Plastic Surgery, 4070 Lake Dr., Suite 202, Grand Rapids, MI, 49546, USA

    Arif Chaudhry

  3. Spectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids, MI, USA

    Daniella Anderson

  4. Mayo Clinic Plastic Surgery Residency, Rochester, MN, USA

    Khaled O. Alameddine

  5. School of Medicine, Wayne State University, Detroit, MI, 48201, USA

    Jahan Tajran

Authors
  1. Dennis Hammond
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  2. Arif Chaudhry
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  3. Daniella Anderson
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  4. Khaled O. Alameddine
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  5. Jahan Tajran
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Correspondence to Dennis Hammond.

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Hammond, D., Chaudhry, A., Anderson, D. et al. Postsurgical Pyoderma Gangrenosum After Breast Surgery: A Plea for Early Suspicion, Diagnosis, and Treatment. Aesth Plast Surg 44, 2032–2040 (2020). https://doi.org/10.1007/s00266-020-01899-5

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  • DOI: https://doi.org/10.1007/s00266-020-01899-5

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