Patel D K, Locke M, Jarrett P
Department of Plastic, Reconstructive and Hand Surgery, Middlemore Hospital, Counties Manukau District Health Board, 100 Hospital Road, Private Bag 93311, Otahuhu, Auckland, New Zealand.
Department of Plastic, Reconstructive and Hand Surgery, Middlemore Hospital, Counties Manukau District Health Board, 100 Hospital Road, Private Bag 93311, Otahuhu, Auckland, New Zealand; Department of Surgery, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand.
J Plast Reconstr Aesthet Surg. 2017 Jul;70(7):884-892. doi: 10.1016/j.bjps.2017.03.013. Epub 2017 Apr 12.
The failure of postoperative surgical site infection to resolve after appropriate antibiotic therapy should alert the clinician to other diagnoses. Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that is typically characterized by necrotizing ulceration. PG can be exacerbated by minor trauma leading to exaggerated skin injury, a condition known as pathergy. We present a case series of PG arising after immediate reconstruction for breast oncological surgery from 1st January 2006 to 1st September 2014. 395 immediate breast reconstructions were performed in 335 patients. Three cases of post-surgical PG were identified (0.9%), all in the setting of mastectomy for breast cancer. Two cases underwent immediate reconstruction with pedicled transverse rectus abdominus myocutaneous flaps, and one underwent submuscular expander insertion. A mean delay of 6.3 days was observed from first presentation of symptoms to diagnosis of PG. Immunosuppressants commonly used included methylprednisolone, prednisone, and ciclosporin, with good success at halting disease progress. Significant scarring affected all three women. Once the disease was deemed quiescent, intravenous immunoglobulin used in the perioperative period for further surgical procedures provided favorable results. A diagnostic algorithm is suggested to guide surgeons in investigations and management when post-surgical PG is suspected.
经适当抗生素治疗后手术部位感染仍未痊愈，临床医生应警惕其他诊断。坏疽性脓皮病（PG）是一种炎症性嗜中性皮肤病，通常以坏死性溃疡为特征。轻微创伤可加重PG，导致皮肤损伤加剧，这种情况称为同形反应。我们报告了一组2006年1月1日至2014年9月1日乳腺癌手术即刻重建后发生PG的病例系列。335例患者共进行了395例即刻乳房重建。共确诊3例术后PG（0.9%），均为乳腺癌乳房切除术后。2例行带蒂腹直肌肌皮瓣即刻重建，1例行肌下扩张器植入。从症状首次出现到诊断为PG的平均延迟时间为6.3天。常用的免疫抑制剂包括甲泼尼龙、泼尼松和环孢素，在阻止疾病进展方面取得了良好效果。所有三名女性均有明显瘢痕形成。一旦疾病被认为静止，围手术期用于进一步手术的静脉注射免疫球蛋白取得了良好效果。建议采用一种诊断算法，以指导外科医生在怀疑术后PG时进行调查和处理。
