Postoperative pyoderma gangrenosum: a serious and rare complication after breast reduction


Saki M. C. , Guder H., Karadeniz A., GUDER S. , Akoz T.

JOURNAL FUR ASTHETISCHE CHIRURGIE, vol.12, no.4, pp.186-190, 2019 (Journal Indexed in ESCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 12 Issue: 4
  • Publication Date: 2019
  • Doi Number: 10.1007/s12631-019-0195-2
  • Title of Journal : JOURNAL FUR ASTHETISCHE CHIRURGIE
  • Page Numbers: pp.186-190
  • Keywords: Wound healing, Wound infections, Postoperative pain, Corticosteroids, Tacrolimus

Abstract

This article reports about a 17-year-old female patient who was admitted to this department in early 2019 with painful, necrotizing and destructively spreading skin ulcerations in the scar region after breast reduction. The wound became larger over time with the formation of a yellowish greasy covering. After changing the dressing and application of an antibiotic ointment a tissue sample and a swab from the wound were taken as well as a blood sample. On the second day of hospitalization no improvement in the symptoms could be detected. According to the results of the tissue and blood sample investigations all microbiological tests were negative. Due to the atypical nature of the wound, which developed into deep and very painful ulcerations within a few days, a wound conference was initiated. After a lively discussion on the condition of the wound, the dermatologist proposed the suspected diagnosis of pyoderma gangrenosum. Additionally, the rapid administration of oral corticosteroids (1 mg/kg body weight/day) was prescribed by the dermatologist. Tacrolimus was used instead of antibiotic ointment during the change of dressing. The tissue sample from the margin of the ulcer showed neutrophil-rich infiltration of the dermis with moderate perivascular lymphocyte infiltrates. These histological findings were consistent with pyoderma gangrenosum. The patient was referred to another university hospital 10 days after hospitalization. Pyoderma gangrenosum was also identified there as the main diagnosis and the corticosteroid-tacrolimus treatment was continued.