Ehrl Denis C, Heidekrueger Paul I, Broer P Niclas
Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Marcioninistr. 15, Munich 81377, Germany.
Department of Plastic, Hand, and Reconstructive Surgery, University Medical Centre, Franz-Josef-Strauß-Allee, 93053, Regensburg, Germany.
J Plast Reconstr Aesthet Surg. 2018 Jul;71(7):1023-1032. doi: 10.1016/j.bjps.2018.03.013. Epub 2018 Mar 28.
Post-surgical pyoderma gangrenosum (PSPG) is a rare inflammatory skin disorder of unknown aetiology. Given its similar presentation to wound infection and lack of reliable diagnostic tests as well as pathognomonic clinical features, PSPG is difficult to diagnose. The aim of this review was to identify factors contributing to PSPG to aid with timely diagnosis and appropriate therapy.
A systematic literature review was performed by following PRISMA guidelines, focusing on PSPG after reconstructive and aesthetic breast surgery. The online databases PubMed, Medline, EMBASE, Scopus, and Cochrane were used, and additionally, a Google search was performed.
A total of 68 articles describing 87 cases of PSPG following aesthetic and reconstructive breast surgery were found. The majority of PSPG (44%) occurred after breast reduction surgery and microsurgical breast reconstruction (16%). The most common associated conditions were malignancies in 37% and autoimmune deficiencies in 17%. Microbiological examinations were found to have a negative result in 90%. The median time from initial presentation with symptoms to correct diagnosis of PG was on average 12.5 days, with unsuccessful first-line therapy on average for 20.0 days. After the diagnosis of PG, medical therapy most commonly involved steroids in 84% and/or Cyclosporine A in 22% of the cases. On average, the duration of this therapy was 4.7 months.
The diagnosis of PSPG remains a challenging issue. However, according to the presented review, several distinct clinical signs in combination with lack of treatment response should prompt further investigation to promote timely diagnosis and correct treatment of this potentially debilitating disease.
手术后坏疽性脓皮病（PSPG）是一种病因不明的罕见炎症性皮肤病。鉴于其临床表现与伤口感染相似，且缺乏可靠的诊断测试以及特征性临床特征，PSPG难以诊断。本综述的目的是确定导致PSPG的因素，以帮助及时诊断和进行适当治疗。
按照PRISMA指南进行系统的文献综述，重点关注整形和美容乳房手术后的PSPG。使用了在线数据库PubMed、Medline、EMBASE、Scopus和Cochrane，此外还进行了谷歌搜索。
共发现68篇文章描述了87例美容和重建乳房手术后发生PSPG的病例。大多数PSPG（44%）发生在乳房缩小手术和显微外科乳房重建术后（16%）。最常见的相关疾病是恶性肿瘤（37%）和自身免疫缺陷（17%）。微生物学检查结果90%为阴性。从最初出现症状到正确诊断PG的中位时间平均为12.5天，一线治疗平均失败20.0天。诊断为PG后，药物治疗最常见的是84%的病例使用类固醇和/或22%的病例使用环孢素A。这种治疗的平均持续时间为4.7个月。
PSPG的诊断仍然是一个具有挑战性的问题。然而，根据本综述，一些明显的临床体征加上缺乏治疗反应应促使进一步调查，以促进对这种可能使人衰弱的疾病的及时诊断和正确治疗。
