Cabalag Miguel Suhady, Wasiak Jason, Lim Shueh Wen, Raiola Frank Bruscino
From the Plastic, Hand & Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
Ann Plast Surg. 2015 Mar;74(3):354-60. doi: 10.1097/SAP.0b013e31829565f3.
Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic skin condition of unknown etiology. The disease continues to pose therapeutic challenges, with ongoing controversy regarding the role of surgery.
A retrospective medical records review was conducted for 29 patients who were diagnosed and treated for PG at an Australian tertiary center over 10 years, from 1 January 2000 to 31 December 2010.
A total of 29 patients had a diagnosis of PG, with a total of 35 admissions. Nearly all patients had immunosuppressant therapy and 10 (35%) patients underwent surgery. Eight (28%) received hyperbaric oxygen therapy. Complications secondary to medical therapy occurred in 23 (66%) of admissions, with the commonest being poor blood sugar control in patients with diabetes (n = 6, 17%) and steroid-induced diabetes (n = 5, 14%). At discharge, 21 (72%) patients' ulcers had improved and there were 4 (14%) inpatient deaths. At 6 months, 3 of 10 cases with available follow-up showed complete ulcer healing. Most of the patients (n = 8, 80%) who underwent combined medical and surgical therapy had ulcers that had either completely healed or improved at 6 months after discharge. All 3 patients who underwent split skin grafting under immunosuppressive cover (with 2 having hyperbaric oxygen therapy) had no postoperative graft failure or pathergy.
Pyoderma gangrenosum remains a therapeutic challenge, with significant complications and morbidity from long-term medical treatment. Surgery should be considered in conjunction with combined hyperbaric and immunosuppressive therapy once the disease is quiescent, to reduce disease-related comorbidity as well as the consequent adverse effects of long-term immunosuppressant therapy.
坏疽性脓皮病（PG）是一种病因不明的罕见溃疡性中性粒细胞性皮肤病。该疾病仍然带来治疗挑战，关于手术的作用存在持续争议。
对2000年1月1日至2010年12月31日期间在澳大利亚一家三级中心诊断并治疗PG的29例患者进行回顾性病历审查。
共有29例患者被诊断为PG，共入院35次。几乎所有患者都接受了免疫抑制治疗，10例（35%）患者接受了手术。8例（28%）接受了高压氧治疗。药物治疗继发的并发症在23例（66%）入院患者中出现，最常见的是糖尿病患者血糖控制不佳（n = 6，17%）和类固醇诱导的糖尿病（n = 5，14%）。出院时，21例（72%）患者的溃疡有所改善，4例（14%）患者住院死亡。在6个月时，10例有随访资料的患者中有3例溃疡完全愈合。大多数接受药物和手术联合治疗的患者（n = 8，80%）在出院后6个月时溃疡完全愈合或有所改善。所有3例在免疫抑制覆盖下接受植皮手术的患者（其中2例接受了高压氧治疗）均未出现术后移植失败或同形反应。
坏疽性脓皮病仍然是一个治疗挑战，长期药物治疗会导致严重并发症和发病率。一旦疾病静止，应考虑将手术与高压氧和免疫抑制联合治疗相结合，以减少与疾病相关的合并症以及长期免疫抑制治疗的不良后果。
