Unusual cause of breast wound: postoperative pyoderma gangrenosum

Postoperative pyoderma gangrenosum (PPG) is an unusual clinical entity, which shows rapidly progressive skin necrosis that can occur within surgical sites after any surgical procedure. Usually, it is diagnosed as wound infection at the time of presentation, but antibiotic therapy and wound debridement fail to arrest rapid ulcer enlargement. We report the case of PPG in a 21‐year‐old woman after a reduction mammoplasty surgery. In this report, we emphasise the importance of considering pyoderma gangrenosum (PG) as one of the differential diagnoses of breast ulcers after surgical procedures. Careful clinical assessment may establish an early diagnosis and prevent potential serious complications.     

一例坏疽性脓皮病合并肺部空洞患者的护理

正坏疽性脓皮病(Pyoderma gangrenosum,PG)由Brunsting、Goeekerman和OLeary于1930年首先报道。它是一种皮肤复发性坏死性溃疡且伴有局部疼痛的皮肤病,本病少见,常见于30~50岁,且女性多于男性[1]。坏疽性脓皮病可为特发性,但约有50%坏疽性脓皮病患者同时患有其他系统性疾病,主要包括炎性肠病、关节炎和血液系统恶性肿瘤等[2]。我院     

Portable negative‐pressure wound therapy for pyoderma gangrenosum: Report of two cases

Pyoderma gangrenosum is a chronic non‐infectious neutrophilic dermatosis that causes undermining ulcers. Topical therapies for the deep ulcers of pyoderma gangrenosum have not been established. To investigate whether negative‐pressure wound therapy is effective for a pyoderma gangrenosum ulcer, we used the PICO single use negative‐pressure wound therapy system (Smith & Nephew, London, UK) for two pyoderma gangrenosum patients. In these cases, the ulcers decreased in size and necrolytic tissue was removed notably. Moreover, there were no secondary infections nor was there Koebner phenomena. Our cases suggest that portable negative‐pressure wound therapy can be a treatment option for deep, intractable ulcers caused by pyoderma gangrenosum. Because portable negative‐pressure wound therapy devices afford increased mobility to patients, they can give the patient a better quality of life than standard negative‐pressure wound therapy systems do.     

Pyoderma gangrenosum and underlying diseases in Japanese patients: A regional long‐term study

Pyoderma gangrenosum (PG) is a chronic inflammatory disease of unknown cause that presents as an inflammatory and ulcerative disorder of the skin. PG is often associated with an underlying systemic disease. However, the frequencies of the underlying diseases are unclear in Japanese patients. In this retrospective, observational study, all patients diagnosed with PG who visited dermatology departments of nine regional hospitals in and around Ibaraki Prefecture were collected from 1982 to 2011 or 2014. The diagnoses of PG were based on the characteristic clinical and histological appearances and ruling out of infection. Sixty‐two PG patients, including 29 males and 33 females, were identified. The ages of onset were 16–89 years, and the mean age was 50.2 years. Fifty (80%) of the 62 patients presented with an ulcerative PG, and the lower leg was the most common site (74%). Forty‐six (74%) PG patients had underlying diseases. The most frequent was ulcerative colitis (32%), followed by myelodysplastic syndrome (11%), rheumatoid arthritis (6%) and aortitis syndrome (5%). For treatment, 54 cases (87%) received systemic corticosteroids and 10 received additional treatment with cyclosporin. There was no significant correlation between underlying diseases and response to the initial treatment. Multivariate analysis revealed that the number of affected sites negatively correlated with successful initial treatment. Fifteen (24%) of the 62 cases relapsed. In conclusion, ulcerative colitis and hematological disorders were frequently associated with PG while approximately a quarter of the cases were idiopathic.     

坏疽性脓皮病治验7例

目的回顾坏疽性脓皮病的临床资料,避免其误诊误治。方法在糖皮质激素、免疫抑制剂和敏感抗生素治疗的基础上,以自拟四叶宣解汤宣化清解、活血散结,兼祛风寒湿邪。结果 7例坏疽性脓皮病患者中,5例疮口愈合,2例死亡,其中1例确诊为白血病,1例未确诊原发疾病者转外院治疗后死亡。结论坏疽性脓皮病常合并其他疾病,皮损程度较重,病程长,经年不愈,易被误诊。在早期使用糖皮质激素和免疫抑制剂治疗的基础上,服用解毒化瘀散结、祛风寒湿邪中药可明显提高疗效。