Dhooghe Nicholas, Oieni Sebastiano, Peeters Patrick, D'Arpa Salvatore, Roche Nathalie
a Department of Plastic, Reconstructive and Aesthetic surgery , Ghent University Hospital , Ghent , Belgium.
b Department of Plastic Surgery , University of Palermo , Palermo , Italy.
Acta Chir Belg. 2017 Apr;117(2):69-76. doi: 10.1080/00015458.2016.1264729. Epub 2016 Dec 9.
Post Surgical Pyoderma Gangrenosum (PSPG) is a neutrophilic dermatosis causing aseptic necrotic ulcerations within surgical sites. It is often misdiagnosed as infection or ischemia and worsened by the inappropriate treatment. Therefore diagnostic clues must be identified and awareness for PSPG raised.
We present two cases of PSPG after flap surgery and a review of the literature.
Seventeen cases of PSPG after flap surgery were found. Fever, pain and redness are the most common initial symptoms. In 63%, lesions were on the flap and the adjacent skin. In 63%, the donor site is also involved. Time to diagnosis was nine days to four years. Frequent debridement (89%) and administration of antibiotics (74%) illustrate the misdiagnosis of infection or ischemia. PSPG in flap surgery seems to be less associated with underlying diseases, than other forms of Pyoderma Gangrenosum. Corticoids are the most commonly used treatment. Of the 19 cases, 10 experienced partial or total flap loss.
PSPG must be included in the differential diagnosis of postoperative wound problems. Recognizing the diagnostic clues can lead to early diagnosis and treatment with systemic immunotherapy. Associated diseases should be investigated and additional surgery can only be successful when associated with immunotherapy.
手术后坏疽性脓皮病（PSPG）是一种中性粒细胞性皮肤病，可在手术部位引起无菌性坏死性溃疡。它常被误诊为感染或缺血，且不恰当的治疗会使其恶化。因此，必须识别诊断线索并提高对PSPG的认识。
我们报告了两例皮瓣手术后发生PSPG的病例并对文献进行了综述。
共发现17例皮瓣手术后发生PSPG的病例。发热、疼痛和发红是最常见的初始症状。63%的病例病变位于皮瓣及相邻皮肤。63%的病例供皮区也受累。诊断时间为9天至4年。频繁清创（89%）和使用抗生素（74%）表明存在感染或缺血的误诊。与其他形式的坏疽性脓皮病相比，皮瓣手术中的PSPG似乎与基础疾病的关联较小。皮质类固醇是最常用的治疗方法。19例病例中，10例出现了部分或全部皮瓣丢失。
PSPG必须纳入术后伤口问题的鉴别诊断。识别诊断线索可实现早期诊断并采用全身免疫疗法进行治疗。应调查相关疾病，只有在与免疫疗法联合时，额外的手术才可能成功。
