Akademik Veri Yönetim Sistemi
2025 EADV CONGRESS, Paris, Fransa, 17 - 20 Eylül 2025, ss.51-52, (Özet Bildiri)
Introduction
& Objectives
Pyoderma
gangrenosum (PG) is an uncommon inflammatory and ulcerative skin disorder,
histopathologically characterised by the accumulation of neutrophils
in the skin. Postsurgical PG (PSPG) is defined as the development of PG at the
surgical site and typically develops within an average of 7 days after surgery.
[1] The condition is commonly diagnosed as a wound infection at presentation;
nevertheless, treatment with antibiotics and wound debridement does not prevent
the ulcer from progressing rapidly. The initial symptoms include surgical- site
erythema and extreme pain. The majority of PSPG cases occur after breast
surgery, particularly reduction mammoplasty procedures. Interestingly, over 50%
of these cases involve bilateral breast procedures, resulting in bilateral PG. [2]
Materials
& Methods
This report
presents two cases of PG following bilateral reduction mammoplasty
Results
Case 1
A
63-year-old female patient was admitted to the plastic & reconstructive surgery department (PRS) on day 6 after
bilateral reduction mammoplasty for IV antibiotic initiation due to redness and
discharge at the wound site, initially suspected to be a wound infection. After
5 days of systemic antibiotic treatment with no clinical improvement, the
patient was referred to the dermatology department. Dermatological examination revealed
inverted T-shaped reduction mammoplasty scars in the bilateral periareolar
areas, with ulcers measuring 10x10 cm and irregular, sharply demarcated necrotic tissue at the lower
border of the scars, while the areolar areas remained intact. (Figure 1) The
patient was diagnosed with PG based on clinical and histopathological
evaluation and was admitted to the dermatology inpatient department for IV
steroids and wound care. The patient’s ulcers completely healed within six
months following the addition of topical tacrolimus and the stepwise reduction
of systemic corticosteroids, initially prescribed at 60 mg. (Figure 2 )
Case
2
A
24-year-old female patient was referred to the dermatology department from PRS
on the fifth day after bilateral reduction mammoplasty due to fever and wound
discharge. Dermatological examination revealed two annular ulcers measuring 3x3 cm, covered with granulation
tissue, on the inferior bilateral areolae, and two necrotic ulcers measuring
5x5 cm in proximity to these, while the areolar areas were preserved. (Figure 3
) Tissue and bacterial cultures were obtained and the results were negative.
The patient was diagnosed with PG based on clinical and histopathologic
evaluation. Following treatment with oral steroids, topical antibiotics, and
tacrolimus, near-complete epithelialization of the ulcers was observed.
Furthermore, a second surgical procedure was performed at the patient's request
to facilitate wound closure. The ulcers healed almost completely after 3
months. (Figure 4)
Conclusion
Postoperative
PG is a diagnosis of exclusion and should be suspected when surgical wounds
fail to improve despite appropriate postoperative antibiotic therapy. [3]
Initial treatment includes systemic steroids and wound care. Other
immunosuppressive agents, such as cyclosporine or infliximab, may be used in
refractory cases. [4] Although surgical reconstruction is generally not
recommended due to the risk of pathergy, it may be beneficial in some cases. [5]
No consensus currently exists on the diagnosis and treatment of PSPG, and
prospective randomized controlled trials are needed.