Division of Plastic Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria.
J Plast Reconstr Aesthet Surg. 2010 Jul;63(7):e564-7. doi: 10.1016/j.bjps.2009.12.013. Epub 2010 Feb 11.
If diagnosed late, post-surgical pyoderma gangrenosum (PSPG) is a rare, tricky and potentially life-threatening complication. Once diagnosed, immunosuppressive agents may provoke further complications. Well-intentioned extensive serial debridement may cause deep skin and soft-tissue defects, requiring skin grafting and possible flap surgery. The combination of necessary immunosuppressive treatment, protracted hospital stay and broad-spectrum systemic antimicrobial therapy may encourage serious acquired multidrug resistance (MDR). We report an unfortunate triad following breast reconstruction of PSPG, full-thickness chest wall defect and MDR with Acinetobacter baumannii infection. Interdisciplinary treatment using free flap surgery and negative-pressure wound therapy with instillation therapy (V.A.C.Instill(R) Wound Therapy) enabled survival and complete wound closure.
如果诊断较晚，手术后坏疽性脓皮病（PSPG）是一种罕见、棘手且可能危及生命的并发症。一旦确诊，免疫抑制剂可能会引发进一步的并发症。出于善意的广泛连续清创可能会导致深部皮肤和软组织缺损，需要植皮和可能的皮瓣手术。必要的免疫抑制治疗、长期住院和广谱全身抗菌治疗可能会导致严重的获得性多药耐药（MDR）。我们报告了一例不幸的三联征，即 PSPG 乳房重建、全层胸壁缺损和多重耐药鲍曼不动杆菌感染。使用游离皮瓣手术和负压伤口治疗联合灌洗治疗（V.A.C.Instill(R) 伤口治疗）的多学科治疗使患者得以存活并完全闭合伤口。
