Ehrl DC, Heidekrueger PI, Broer PN, et al.
Journal of plastic, reconstructive & aesthetic surgery : JPRAS. Date of publication 2018 Jul 1;volume 71(7):1023-1032.
1. J Plast Reconstr Aesthet Surg. 2018 Jul;71(7):1023-1032. doi:
10.1016/j.bjps.2018.03.013. Epub 2018 Mar 28.
Pyoderma gangrenosum after breast surgery: A systematic review.
Ehrl DC(1), Heidekrueger PI(2), Broer PN(3).
Author information:
(1)Department of Hand, Plastic and Aesthetic Surgery,
Ludwig-Maximilians-University Munich, Marcioninistr. 15, Munich 81377, Germany.
Electronic address: Dr.D.Ehrl@gmail.com.
(2)Department of Plastic, Hand, and Reconstructive Surgery, University Medical
Centre, Franz-Josef-Strauß-Allee, 93053, Regensburg, Germany.
(3)Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen
Academic Hospital, Engelschalkingerstr. 77, 81925, Munich, Germany.
BACKGROUND: Post-surgical pyoderma gangrenosum (PSPG) is a rare inflammatory skin
disorder of unknown aetiology. Given its similar presentation to wound infection
and lack of reliable diagnostic tests as well as pathognomonic clinical features,
PSPG is difficult to diagnose. The aim of this review was to identify factors
contributing to PSPG to aid with timely diagnosis and appropriate therapy.
METHODS: A systematic literature review was performed by following PRISMA
guidelines, focusing on PSPG after reconstructive and aesthetic breast surgery.
The online databases PubMed, Medline, EMBASE, Scopus, and Cochrane were used, and
additionally, a Google© search was performed.
RESULTS: A total of 68 articles describing 87 cases of PSPG following aesthetic
and reconstructive breast surgery were found. The majority of PSPG (44%) occurred
after breast reduction surgery and microsurgical breast reconstruction (16%). The
most common associated conditions were malignancies in 37% and autoimmune
deficiencies in 17%. Microbiological examinations were found to have a negative
result in 90%. The median time from initial presentation with symptoms to correct
diagnosis of PG was on average 12.5 days, with unsuccessful first-line therapy on
average for 20.0 days. After the diagnosis of PG, medical therapy most commonly
involved steroids in 84% and/or Cyclosporine A in 22% of the cases. On average,
the duration of this therapy was 4.7 months.
CONCLUSION: The diagnosis of PSPG remains a challenging issue. However, according
to the presented review, several distinct clinical signs in combination with lack
of treatment response should prompt further investigation to promote timely
diagnosis and correct treatment of this potentially debilitating disease.
Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic
Surgeons. Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.bjps.2018.03.013
PMID: 29748073 [Indexed for MEDLINE]
