Loomis Reilly, Merrit Mellanie, Aleshin Maria Alexandrovna, Graw Grace, Lee Gordon, Graw Bradley
Palo Alto Medical Foundation, Center for Total Joint Replacement, Palo Alto, CA.
Sequoia Hospital, Center for Joint Replacement, Redwood City, CA.
Arthroplast Today. 2021 Aug 26;11:73-79. doi: 10.1016/j.artd.2021.07.003. eCollection 2021 Oct.
Pyoderma gangrenosum is a neutrophilic dermatosis, which mimics both infection and necrotizing fasciitis, that can present after surgical interventions. We present the case of a 62-year-old male who underwent one-stage bilateral total knee arthroplasty. Nine days after the surgery, he presented with wound breakdown, high fever, and elevated white blood cell count. Repeated debridement was performed, and empiric antibiotics were given. All tissue cultures and aspirates remained negative throughout treatment course, and the patient remained unresponsive to therapy. The patient was eventually diagnosed with pyoderma gangrenosum after infectious etiologies were ruled out and after a skin biopsy and dermatologic consultation. His condition rapidly improved after treatment with corticosteroids, and soft-tissue defects were repaired with skin substitute and full-thickness skin grafting. In patients with aseptic wound breakdown after total knee arthroplasty, pyoderma gangrenosum is a rare but devastating complication and should be considered.
坏疽性脓皮病是一种嗜中性皮病，可在外科手术后出现，它既类似感染又类似坏死性筋膜炎。我们报告一例62岁男性患者，该患者接受了一期双侧全膝关节置换术。术后九天，他出现伤口裂开、高热及白细胞计数升高。反复进行清创，并给予经验性抗生素治疗。在整个治疗过程中，所有组织培养和抽吸物均为阴性，患者对治疗无反应。在排除感染性病因后，经皮肤活检及皮肤科会诊，该患者最终被诊断为坏疽性脓皮病。使用皮质类固醇治疗后，他的病情迅速改善，软组织缺损采用皮肤替代物和全厚皮片移植进行修复。在全膝关节置换术后出现无菌性伤口裂开的患者中，坏疽性脓皮病是一种罕见但具有破坏性的并发症，应予以考虑。
