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Yamamoto T, Yamasaki K, Yamanaka K, Komine M, Kawakami T, Yamamoto O, Kanekura T, Higuchi T, Takahashi T, Matsushima Y, Kikuchi N. Clinical guidance of pyoderma gangrenosum 2022. J Dermatol 2023; 50:e253-e275. [PMID: 37311717 DOI: 10.1111/1346-8138.16845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, neutrophilic skin disease. For the purpose of accurate diagnosis and proper treatment of PG, the Japanese clinical practice guidance for PG developed by the Japanese Dermatological Association was published in 2022. In this guidance, clinical aspects, pathogenesis, current therapies, and clinical questions on PG are described from the viewpoints of current knowledge and evidence-based medicine. Here, the English version of the Japanese clinical practice guidelines for PG is presented and is intended to be widely referred to in the clinical examination and treatment of PG.
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Loomis R, Merrit M, Aleshin MA, Graw G, Lee G, Graw B. Pyoderma Gangrenosum After Bilateral Total Knee Arthroplasty. Arthroplast Today 2021; 11:73-79. [PMID: 34485653 PMCID: PMC8397920 DOI: 10.1016/j.artd.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022] Open
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis, which mimics both infection and necrotizing fasciitis, that can present after surgical interventions. We present the case of a 62-year-old male who underwent one-stage bilateral total knee arthroplasty. Nine days after the surgery, he presented with wound breakdown, high fever, and elevated white blood cell count. Repeated debridement was performed, and empiric antibiotics were given. All tissue cultures and aspirates remained negative throughout treatment course, and the patient remained unresponsive to therapy. The patient was eventually diagnosed with pyoderma gangrenosum after infectious etiologies were ruled out and after a skin biopsy and dermatologic consultation. His condition rapidly improved after treatment with corticosteroids, and soft-tissue defects were repaired with skin substitute and full-thickness skin grafting. In patients with aseptic wound breakdown after total knee arthroplasty, pyoderma gangrenosum is a rare but devastating complication and should be considered.
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Affiliation(s)
- Reilly Loomis
- Palo Alto Medical Foundation, Center for Total Joint Replacement, Palo Alto, CA
| | - Mellanie Merrit
- Sequoia Hospital, Center for Joint Replacement, Redwood City, CA
| | | | - Grace Graw
- Department of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Gordon Lee
- Department of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Bradley Graw
- Palo Alto Medical Foundation, Center for Total Joint Replacement, Palo Alto, CA
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Almeida IR, Coltro PS, Gonçalves HOC, Westin AT, Almeida JB, Lima RVKS, Silva MF, Farina Junior JA. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience. Wound Repair Regen 2021; 29:486-494. [PMID: 33772964 DOI: 10.1111/wrr.12910] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according to the PRISMA guidelines) on the use of NPWT in the treatment of PG, and we report our personal experience with two patients treated with this device. The result of the review showed that articles on the topic are, in their entirety, of low levels of evidence, such as case series, case reports, and reviews. Improvement in wound healing with the use of NPWT was observed in 85.1% of the patients studied. Besides, a significant association between improvement in wound healing with NPWT and immunosuppressive therapy was observed. Regarding the cases reported here, both showed good outcomes with the use of NPWT and skin graft during the treatment of PG injuries. Due to the rarity of PG, there is a scarcity of studies with robust evidence for standardization and comparison between treatments, which consequently makes it difficult to select therapeutic options. However, based on this systematic review and reported cases, we consider NPWT a safe option for adjuvant treatment of wounds caused by PG if combined with systemic immunosuppression, which plays a key role in greater chances of successful treatment. This approach should be recommended, whenever possible, associated with skin grafting to accelerate wound closure. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: a systematic review and personal experience.
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Affiliation(s)
- Ivan R Almeida
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pedro S Coltro
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Henrique O C Gonçalves
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Andrezza T Westin
- Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Juliano B Almeida
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Renan V K S Lima
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcelo F Silva
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jayme A Farina Junior
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Eisendle K, Thuile T, Deluca J, Pichler M. Surgical Treatment of Pyoderma Gangrenosum with Negative Pressure Wound Therapy and Skin Grafting, Including Xenografts: Personal Experience and Comprehensive Review on 161 Cases. Adv Wound Care (New Rochelle) 2020; 9:405-425. [PMID: 32320362 DOI: 10.1089/wound.2020.1160] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Significance: Pyoderma gangrenosum (PG) is a rare debilitating autoinflammatory ulcerative skin disease. No gold standard has been established for the treatment of PG. The role of surgical interventions and negative pressure wound therapy (NPWT) was discussed controversially until recently as these procedures might pose a trigger to further aggravate the condition. Recent Advances: Recent advances confirm the paradigm change that a surgical approach of PG with split thickness skin grafting (STSG) secured by NPWT is a safe and valuable treatment if performed under adequate immunosuppression. We elaborate this on the hand of a broad literature search retrieving 101 relevant articles describing 138 patients complemented with our personal experience on 23 patients, including 2 patients treated with a porcine xenodressing. Critical Issues: A wide range of surgical approaches have been reported, including xenografts. Treatment was finally successful in 86%, including the xenotransplant cases. Ten percent improved and failures were mainly reported without immunosuppression. Despite halting the inflammatory process, NPWT alone, without skin grafting, does not much accelerate healing time. The best surgical approach appears to be STSG fixed with NPWT as this leads to higher skin graft take. There remains the problem of the chronic nature of PG and the recurrence after tapering of immunosuppression or trauma; therefore, a sustained immunosuppressive treatment is suggested. Future Directions: While surgical treatment is supported by the published data, the exact immunosuppression is still evolving. Due to deeper insights into pathogenesis and growing clinical reports, a broader utilization of biologic treatments and a shift from tumor necrosis factor (TNF)-alpha to interleukin (IL)-12/23 or IL-23 antibodies alone are predictable, as IL-12/23 antibodies show good clinical responses with fewer side effects. The positive results with porcine xenodressings might be due to immunological effects of the xenomaterial; they appear promising, but are preliminary and should be confirmed in a larger patient collective.
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Affiliation(s)
- Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
- IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano/Bozen, Italy
| | - Tobias Thuile
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Jenny Deluca
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Maria Pichler
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
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Chen ZQ, Huang JF, Ma LL, Zhang CL, Lei S. Usefulness of metagenomic analysis in differential diagnosis for pyoderma gangrenosum. J Int Med Res 2018; 46:3468-3473. [PMID: 29936877 PMCID: PMC6134661 DOI: 10.1177/0300060518780124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative inflammatory dermatosis easily confused with wound infection following surgery. There have been seven case reports of PG occurring after total knee arthroplasty (TKA), all of which used routine tissue culture for differential diagnosis. Notably, all previous cases involved delayed diagnosis. We report a case of PG after TKA where we used shotgun metagenomics for differential diagnosis. Metagenomic analysis is a new method that can be used for pathogen detection; it is fast and sensitive, compared with traditional culture. Early application of metagenomic analysis in cases of suspicious wound infection after surgery can detect the pathogen of the infection for target therapy; it can also exclude infection for differential diagnosis of non-infectious diseases, such as autoimmune disorders. This case is presented to support the use of metagenomic analysis by surgeons and physicians for early and rapid differential diagnosis in patients who exhibit postoperative wound infections.
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Affiliation(s)
- Zhe-Qi Chen
- 1 Department of ICU, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Jie-Feng Huang
- 2 Department of Orthopedics, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Li-Li Ma
- 3 Department of Dermatology, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Chun-Li Zhang
- 4 Department of Pathology, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Shu Lei
- 1 Department of ICU, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China
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Ebrad S, Severyns M, Benzakour A, Roze B, Derancourt C, Odri GA, Rouvillain JL. Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature. INTERNATIONAL ORTHOPAEDICS 2017; 42:239-245. [PMID: 29119297 DOI: 10.1007/s00264-017-3672-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 10/16/2017] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Stephan Ebrad
- Orthopaedic and Traumatologic Department, Military Hospital Robert Picqué, 351 route de Toulouse, 33140, Villenave d'Ornon, France
| | - Mathieu Severyns
- Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique.
| | - Ahmed Benzakour
- Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
| | - Benoit Roze
- Department of Infectiology, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
| | - Christian Derancourt
- Department of Dermatology, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
| | - Guillaume-Anthony Odri
- Orthopaedic and Traumatologic Department, Lariboisière University Hospital, rue Ambroise Paré, 75010, Paris, France
| | - Jean-Louis Rouvillain
- Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
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Mowlds DS, Kim JJ, Murphy P, Wirth GA. Pyoderma gangrenosum: A case report of bilateral dorsal hand lesions and literature review of management. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255031302100411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Donald S Mowlds
- Aesthetic and Plastic Surgery Institute, University of California, Irvine, California, USA
| | - Jeff J Kim
- Aesthetic and Plastic Surgery Institute, University of California, Irvine, California, USA
| | - Patrick Murphy
- Aesthetic and Plastic Surgery Institute, University of California, Irvine, California, USA
| | - Garrett A Wirth
- Aesthetic and Plastic Surgery Institute, University of California, Irvine, California, USA
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Dhooghe N, Oieni S, Peeters P, D’Arpa S, Roche N. Post Surgical Pyoderma Gangrenosum in flap surgery: diagnostic clues and treatment recommendations. Acta Chir Belg 2017; 117:69-76. [PMID: 27938245 DOI: 10.1080/00015458.2016.1264729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Post Surgical Pyoderma Gangrenosum (PSPG) is a neutrophilic dermatosis causing aseptic necrotic ulcerations within surgical sites. It is often misdiagnosed as infection or ischemia and worsened by the inappropriate treatment. Therefore diagnostic clues must be identified and awareness for PSPG raised. METHODS We present two cases of PSPG after flap surgery and a review of the literature. RESULTS Seventeen cases of PSPG after flap surgery were found. Fever, pain and redness are the most common initial symptoms. In 63%, lesions were on the flap and the adjacent skin. In 63%, the donor site is also involved. Time to diagnosis was nine days to four years. Frequent debridement (89%) and administration of antibiotics (74%) illustrate the misdiagnosis of infection or ischemia. PSPG in flap surgery seems to be less associated with underlying diseases, than other forms of Pyoderma Gangrenosum. Corticoids are the most commonly used treatment. Of the 19 cases, 10 experienced partial or total flap loss. CONCLUSION PSPG must be included in the differential diagnosis of postoperative wound problems. Recognizing the diagnostic clues can lead to early diagnosis and treatment with systemic immunotherapy. Associated diseases should be investigated and additional surgery can only be successful when associated with immunotherapy.
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Affiliation(s)
- Nicholas Dhooghe
- Department of Plastic, Reconstructive and Aesthetic surgery, Ghent University Hospital, Ghent, Belgium
| | - Sebastiano Oieni
- Department of Plastic Surgery, University of Palermo, Palermo, Italy
| | - Patrick Peeters
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Salvatore D’Arpa
- Department of Plastic, Reconstructive and Aesthetic surgery, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Roche
- Department of Plastic, Reconstructive and Aesthetic surgery, Ghent University Hospital, Ghent, Belgium
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Tolkachjov SN, Fahy AS, Cerci FB, Wetter DA, Cha SS, Camilleri MJ. Postoperative Pyoderma Gangrenosum: A Clinical Review of Published Cases. Mayo Clin Proc 2016; 91:1267-79. [PMID: 27489052 DOI: 10.1016/j.mayocp.2016.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 12/12/2022]
Abstract
Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by PG at surgical incisions. It is often misdiagnosed as wound infection, and pathergy may complicate wound debridement. From September 1, 2013, through November 30, 2013, a literature search was conducted of articles published from January 1, 1978, through December 31, 2012. We referenced PubMed, MEDLINE, and Mayo Clinic Libraries using the keywords pyoderma gangrenosum, postoperative pyoderma gangrenosum, postsurgical pyoderma gangrenosum, superficial granulomatous pyoderma, pathergic pyoderma, and pyoderma gangrenosum associated with surgery, incision, breast, and wound dehiscence. In addition, all titles from PubMed with the words pyoderma gangrenosum were reviewed manually for postoperative cases. Of 136 patients, 90 (66%) did not have associated systemic diseases. If a comorbidity was present, hematologic disorders were most common. In addition, 29% (28) of women had predisposing disease vs 53% (19) of men. Women had more frequent breast involvement (P<.001); chest involvement was more common in men (P=.005). Girls and women aged 13 to 64 years had more frequent breast involvement (P=.01). Sites were distributed equally for men regardless of age (P=.40). Antibiotic drug therapy was begun and debridement occurred in 90% (110 of 122 treated patients) and 73% (90 of 123 available patients), respectively. Postoperative PG has less association with systemic disease than its nonpostoperative counterpart. Antibiotic drug therapy is routinely initiated. Affected sites are often debrided, causing additional wound breakdown. Early diagnosis may prevent complications.
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Affiliation(s)
| | | | - Felipe B Cerci
- Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba, Brazil
| | | | - Stephen S Cha
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Burnett RSJ, Nair R, Sawyer DM, Zbar AZ, Mathers JW. Pyoderma Gangrenosum in Revision Total Hip Arthroplasty: Clinical and Histopathological Findings with a Seven-Year Follow-up: A Case Report. JBJS Case Connect 2015; 5:e113. [PMID: 29252819 DOI: 10.2106/jbjs.cc.o.00067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We describe the clinical and histopathological findings associated with a case of pyoderma gangrenosum (PG) after revision total hip arthroplasty. The patient developed an expanding purple-red, necrotic, ulcerative lesion at the surgical site, which was initially suspected to be either a surgical-site infection or warfarin-induced skin necrosis. After treatment with empiric intravenous antibiotics, surgical debridement, and vacuum-assisted closure of the wound, the patient had a painless hip with a remodeled scar and was asymptomatic at the seven-year follow-up. CONCLUSION Confirmation of the diagnosis of surgical-site PG requires clinical-pathological correlation and familiarity with the PG skin lesion. Treatment of PG differs from treatment of infection; therefore, misdiagnosis and surgical treatment may exacerbate the clinical findings in PG.
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Affiliation(s)
- R Stephen J Burnett
- Department of Orthopaedic Surgery, University of British Columbia, Island Health, Royal Jubilee Hospital, Rebalance MD, Suite 104, 3551 Blanshard Street, Victoria, BC V8Z-0B9, Canada
| | - Rajesh Nair
- Rebalance MD, Suite 104, 3551 Blanshard Street, Victoria, BC V8Z-0B9
| | - Douglas M Sawyer
- Department of Anatomic Pathology, University of British Columbia, Island Health, Royal Jubilee Hospital, 5th floor, 1952 Bay Street, Victoria, BC V8R-1J8, Canada
| | - Ariella Z Zbar
- Island Medical Program, Medical Science Building, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W-2Y2, Canada
| | - James W Mathers
- Island Medical Program, Medical Science Building, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W-2Y2, Canada
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Management of pyoderma gangrenosum with combination of systemic treatment, vacuum-assisted closure and synthetic dermal substitute. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1147-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Gravvanis A, Kyriakopoulos A, Kateros K, Tsoutsos D. Flap reconstruction of the knee: A review of current concepts and a proposed algorithm. World J Orthop 2014; 5:603-613. [PMID: 25405089 PMCID: PMC4133468 DOI: 10.5312/wjo.v5.i5.603] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/20/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.
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Wollina U, Tchernev G. Pyoderma gangrenosum: pathogenetic oriented treatment approaches. Wien Med Wochenschr 2014; 164:263-73. [DOI: 10.1007/s10354-014-0285-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 05/01/2014] [Indexed: 01/10/2023]
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Fraccalvieri M, Fierro MT, Salomone M, Fava P, Zingarelli EM, Cavaliere G, Bernengo MG, Bruschi S. Gauze-based negative pressure wound therapy: a valid method to manage pyoderma gangrenosum. Int Wound J 2012; 11:164-8. [PMID: 22891652 DOI: 10.1111/j.1742-481x.2012.01058.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon ulcerative, non-infective chronic inflammatory skin disorder of unknown aetiology. Systemic therapies are necessary to control the associated medical diseases, and, due to the inflammatory nature of PG, topical or systemic immunosuppressant agents are effective, but wound healing is usually slow. Negative wound pressure therapy (NPWT) has become an important tool for the management of complex skin ulcers, and usage in PG has been recently described in the literature: we present four cases of classic PG in which NPWT in association with systemic therapy achieved wound healing and a drastic pain reduction.
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Affiliation(s)
- Marco Fraccalvieri
- Plastic Surgery Department, University of Turin, San Giovanni Battista di Torino, Via Cherasco 23, Turin, ItalyDepartment of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Turin, San Giovanni Battista di Torino, Via Cherasco 23, Turin, Italy
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