Pyoderma Gangrenosum Following Bilateral Deep Inferior Epigastric Perforator Flaps

Background

Pyoderma gangrenosum (PG) is an atypical ulcerative cutaneous condition, with an estimated six cases per million people per year in the United States.[1] One-half of patients have idiopathic disease, and it is most commonly associated with underlying systemic inflammatory conditions or hematologic malignancies.[1] [2] There have been several reported cases of PG following breast reduction procedures; however, postsurgical PG (PSPG) is rarely seen following autologous tissue breast reconstruction.[3]

In this article, the authors report the clinical course, treatment, and outcome of a patient diagnosed with PSPG following a delayed breast reconstruction with bilateral deep inferior epigastric perforator (DIEP) flaps. The objective of reporting this case is to further the understanding of the clinical presentation and treatment of PSPG as a complication in patients who present with cutaneous ulcerations following autologous tissue breast reconstruction.

• References

• 1 Schadt C. Pyoderma gangrenosum: pathogenesis, clinical features, and diagnosis. Waltham, MA: UpToDate; 2014. . Available at http://www.uptodate.com/contents/pyoderma-gangrenosum-pathogenesis-clinical-features-and-diagnosis . Accessed on July 8, 2015
• 2 Callen JP. Pyoderma gangrenosum. Lancet 1998; 351 (9102) 581-585
• 3 Momeni A, Satterwhite T, Eggleston III JM. Postsurgical pyoderma gangrenosum after autologous breast reconstruction: case report and review of the literature. Ann Plast Surg 2015; 74 (3) 284-288
• 4 Brunsting LA, Goeckerman WH, O'Leary PA. Pyoderma (echthyma) gangrenosum: clinical and experimental observations in five cases occurring in adults. Arch Derm Syphilol 1930; 22 (4) 655-680
• 5 Farhi D. The clinical and histopathological description of geometric phagedenism (pyoderma gangrenosum) by Louis Brocq one century ago. Arch Dermatol 2008; 144 (6) 755
• 6 Zuo KJ, Fung E, Tredget EE, Lin AN. A systematic review of post-surgical pyoderma gangrenosum: identification of risk factors and proposed management strategy. J Plast Reconstr Aesthet Surg 2015; 68 (3) 295-303
• 7 Caterson SA, Nyame T, Phung T, Lee B, Tobias AM. Pyoderma gangrenosum following bilateral deep inferior epigastric perforator flap breast reconstruction. J Reconstr Microsurg 2010; 26 (7) 475-479
• 8 Tuffaha SH, Sarhane KA, Mundinger GS , et al. Pyoderma gangrenosum after breast surgery: diagnostic pearls and treatment recommendations based on a systematic literature review. Ann Plast Surg 2016; 77 (2) e39-e44