Shafi Ahmed Mohamed Abdel, Atieh Abed Elfattah, Alamouti Reza, Awad Wael Ibrahim
Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
Department of Plastic Surgery, Royal London Hospital, London, UK.
Asian Cardiovasc Thorac Ann. 2021 May;29(4):330-332. doi: 10.1177/0218492320967170. Epub 2020 Oct 12.
A 58-year-old man on azathioprine with a history of ulcerative colitis underwent urgent coronary artery bypass grafting following a myocardial infarction, via a median sternotomy and open harvesting of the long saphenous vein. On postoperative day 5, he developed severe and progressive sternal and leg wound ulceration and necrosis, unresponsive to intravenous antibiotics and requiring surgical debridement. He developed septic shock requiring intensive therapy unit admission. Microbiology was negative and histology supported a diagnosis of pyoderma gangrenosum. Unresponsive to azathioprine and steroid therapy, he underwent a successful skin graft to the leg wound and pectoral reconstruction of the sternal wound.
一名58岁患有溃疡性结肠炎且正在服用硫唑嘌呤的男性，在心肌梗死后接受了紧急冠状动脉搭桥手术，通过正中胸骨切开术并开放采集大隐静脉。术后第5天，他出现了严重且进行性的胸骨和腿部伤口溃疡及坏死，对静脉使用抗生素无反应，需要手术清创。他发展为感染性休克，需要入住重症监护病房。微生物学检查为阴性，组织学检查支持坏疽性脓皮病的诊断。对硫唑嘌呤和类固醇治疗无反应，他接受了腿部伤口的成功皮肤移植和胸骨伤口的胸壁重建。
