Cliff S, Holden C A, Thomas P R, Marsden R A, Harland C C
Department of Dermatology, St Helier Hospital, London, UK.
Dermatol Surg. 1999 Apr;25(4):299-302. doi: 10.1046/j.1524-4725.1999.08193.x.
Pyoderma gangrenosum (PG) is an uncommon necrotising, non-infective ulceration of the skin. The management of PG is aimed at limiting tissue destruction, promoting the healing of the wound, and providing an acceptable cosmetic result. However, skin grafting is normally avoided because of the potential risk of pathergy-the localization of skin damaged by trauma.
We describe the use of split skin grafts in the management of ulcerative pyoderma gangrenosum in 4 patients.
Our cases demonstrate that split skin grafts are a useful treatment modality in patients with ulcerative PG, producing a good cosmetic result. One case illustrates the importance of ensuring the disease is quiescent prior to grafting, to avoid pathergy. The other cases emphasise the need for prolonged immunosuppressive therapy to minimise the chance of reactivation of the disease process.
Our preliminary experience of 4 cases of ulcerative PG indicates that split skin grafts have a role to play in its management. The ultimate cosmetic result is considered to be superior to allowing the wound to heal by secondary intention. To limit the risk of pathergy developing, our experience suggests a role for prolonged courses of immunosuppressive therapy. The most effective dose and duration of immunosuppressive therapy in patients with PG treated with split skin grafts remains to be determined. A controlled study would be of benefit to compare it with other current treatment options.
坏疽性脓皮病（PG）是一种罕见的皮肤坏死性、非感染性溃疡。PG的治疗旨在限制组织破坏，促进伤口愈合，并获得可接受的美容效果。然而，由于存在同形反应的潜在风险（即因创伤而受损的皮肤局部化），通常避免进行皮肤移植。
我们描述了4例溃疡性坏疽性脓皮病患者使用分层皮片移植进行治疗的情况。
我们的病例表明，分层皮片移植对溃疡性PG患者是一种有效的治疗方式，能产生良好的美容效果。1例病例说明了在移植前确保疾病处于静止状态以避免同形反应的重要性。其他病例强调需要长期进行免疫抑制治疗，以尽量减少疾病过程重新激活的可能性。
我们对4例溃疡性PG的初步经验表明，分层皮片移植在其治疗中可发挥作用。最终的美容效果被认为优于让伤口通过二期愈合。为限制发生同形反应的风险，我们的经验表明长期免疫抑制治疗有一定作用。在接受分层皮片移植治疗的PG患者中，免疫抑制治疗的最有效剂量和持续时间仍有待确定。一项对照研究将有助于将其与其他当前治疗选择进行比较。
