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Inpatient Management of Pyoderma Gangrenosum

Treatments, Outcomes, and Clinical Implications

Cabalag, Miguel Suhady MBBS(Hons), BMedSci, PGDipSurgAnat; Wasiak, Jason MPH; Lim, Shueh Wen MBBS(Hons), BMedSci; Raiola, Frank Bruscino MBBS, FRACS

doi: 10.1097/SAP.0b013e31829565f3
Reconstructive Surgery
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Background Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic skin condition of unknown etiology. The disease continues to pose therapeutic challenges, with ongoing controversy regarding the role of surgery.

Methods A retrospective medical records review was conducted for 29 patients who were diagnosed and treated for PG at an Australian tertiary center over 10 years, from 1 January 2000 to 31 December 2010.

Results A total of 29 patients had a diagnosis of PG, with a total of 35 admissions. Nearly all patients had immunosuppressant therapy and 10 (35%) patients underwent surgery. Eight (28%) received hyperbaric oxygen therapy. Complications secondary to medical therapy occurred in 23 (66%) of admissions, with the commonest being poor blood sugar control in patients with diabetes (n = 6, 17%) and steroid-induced diabetes (n = 5, 14%). At discharge, 21 (72%) patients’ ulcers had improved and there were 4 (14%) inpatient deaths. At 6 months, 3 of 10 cases with available follow-up showed complete ulcer healing. Most of the patients (n = 8, 80%) who underwent combined medical and surgical therapy had ulcers that had either completely healed or improved at 6 months after discharge. All 3 patients who underwent split skin grafting under immunosuppressive cover (with 2 having hyperbaric oxygen therapy) had no postoperative graft failure or pathergy.

Conclusions Pyoderma gangrenosum remains a therapeutic challenge, with significant complications and morbidity from long-term medical treatment. Surgery should be considered in conjunction with combined hyperbaric and immunosuppressive therapy once the disease is quiescent, to reduce disease-related comorbidity as well as the consequent adverse effects of long-term immunosuppressant therapy.

From the Plastic, Hand & Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.

Received December 17, 2012, and accepted for publication, after revision, March 27, 2013.

Conflicts of interest and sources of funding: none declared.

Accepted for poster presentation at the 17th International Confederation for Plastics, Reconstructive and Aesthetic Surgery (IPRAS) World Congress, 24 February 2013, Santiago, Chile.

Reprints: Miguel Suhady Cabalag, MBBS(Hons), BMedSci, PGDipSurgAnat, Plastic, Hand & Faciomaxillary Surgery Unit, The Alfred Hospital, Commercial Rd, Melbourne Victoria 3004, Australia. E-mail: miguel.cabalag@gmail.com.

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