Faculty Collaboration Database

Management of Postsurgical Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Role for a Dermal Regeneration Template. Wounds 2021 Nov;33(11):E67-E74

Date

12/10/2021

Pubmed ID

34882573

DOI

10.25270/wnds/2021.e6774

Scopus ID

2-s2.0-85122509718 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

INTRODUCTION: Pyoderma gangrenosum (PG) is a relatively uncommon necrotizing and ulcerative cutaneous disorder. It is often associated with a systemic inflammatory disease but may also present following trauma to the skin due to pathergy. Given its rare occurrence and nonspecific histology, PG is primarily a diagnosis of exclusion, which often results in delayed treatment. Very few cases of PG following autologous breast reconstruction have been reported in the literature, particularly in the absence of systemic disease.

CASE REPORT: Presented is the case of a 62-year-old female with a history of ductal carcinoma in situ who underwent a left breast mastectomy with immediate deep inferior epigastric perforator flap breast reconstruction complicated by fever and leukocytosis as well as erythema, edema, and bullae involving the mastectomy flaps. Initially, necrotizing soft-tissue infection was suspected, and 2 debridements were performed. A diagnosis of PG was made on postoperative day 7, and the patient responded favorably to high-dose prednisone. Reconstruction was performed with a bilayer wound matrix and delayed skin grafting. Despite significant loss of mastectomy skin flap, the free flap was preserved.

CONCLUSIONS: Although PG is a rare complication, it should be considered in the differential diagnosis for patients with atypical presentation of infection following breast reconstruction, even in the absence of systemic inflammatory disease. Early diagnosis and multidisciplinary management may prevent unnecessary surgical intervention and enable flap preservation. Furthermore, bilayer wound matrix placement may be useful as an intermediate reconstruction to determine if it is safe to proceed with skin grafting to avoid further pathergy. The findings in this case suggest that final reconstruction may be safely performed sooner than noted in the literature.

Author List

Ramamurthi A, Adamson KA, Yang KJ, Sanger J, Ling-LeBlanc JP, Wilson B, LoGiudice JA

Authors

John A. LoGiudice MD Professor in the Plastic Surgery department at Medical College of Wisconsin
Barbara D. Wilson MD Professor in the Dermatology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Breast Neoplasms
Female
Humans
Mammaplasty
Mastectomy
Middle Aged
Perforator Flap
Postoperative Complications
Pyoderma Gangrenosum
Regeneration