Hirai Kotaro, Tsuge Itaru, Usui Shunya, Takada Masahiro, Yamanaka Hiroki, Katsube Motoki, Sakamoto Michiharu, Morimoto Naoki
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2022 Feb 15;10(2):e4111. doi: 10.1097/GOX.0000000000004111. eCollection 2022 Feb.
Surgical invasion is a risk factor of pyoderma gangrenosum (PG). A total of 25% of postoperative PG cases were reported to occur after breast surgeries, including bilateral breast reduction and breast reconstruction following cancer resection. Immunosuppressive therapy and less-invasive wound therapy are necessary; however, the complete healing of ulcers takes 5.1 months on average. We herein report a case of skin grafting under a surgical concept of less-invasive and short-term treatment. An 82-year-old woman complained of a high fever and severe pain at her breast wounds after bilateral breast cancer resection. Although we performed emergency debridement surgery to remove the necrotic tissue, suspecting surgical site infection and inflammation, her high fever persisted. She was diagnosed with PG because of the physical findings of characteristic painful, sterile ulcerations, bullae and pustules, and the pathological abundance of neutrophils in the absence of infection and vasculitis. Oral administration of prednisolone 30 mg/day improved the symptoms, and we applied negative-pressure wound therapy (NPWT) from day 16 following debridement surgery. After the gradual reduction of oral steroid intake to 12.5 mg/day, we performed skin grafting surgery. To limit the surgical invasion, we used the surplus skin around the ulcers. Split-thickness mesh skin grafts were fixed by NPWT to avoid the use of tie-over sutures. We achieved short-term treatment of PG with a less-invasive surgical strategy using skin around the ulcers and NPWT.
手术侵袭是坏疽性脓皮病（PG）的一个危险因素。据报道，25%的术后PG病例发生在乳腺手术后，包括双侧乳房缩小术和癌症切除术后的乳房重建术。免疫抑制治疗和微创伤口治疗是必要的；然而，溃疡完全愈合平均需要5.1个月。我们在此报告一例在微创和短期治疗的手术理念下进行皮肤移植的病例。一名82岁女性在双侧乳腺癌切除术后，乳房伤口出现高热和剧痛。尽管我们进行了紧急清创手术以清除坏死组织，怀疑是手术部位感染和炎症，但她的高热仍持续。由于出现特征性疼痛、无菌性溃疡、大疱和脓疱的体格检查结果，以及在无感染和血管炎情况下病理显示中性粒细胞大量增多，她被诊断为PG。口服泼尼松龙30毫克/天可改善症状，我们在清创手术后第16天开始应用负压伤口治疗（NPWT）。在将口服类固醇摄入量逐渐减至12.5毫克/天后，我们进行了皮肤移植手术。为了限制手术侵袭，我们使用了溃疡周围的多余皮肤。采用NPWT固定中厚网状皮肤移植片，避免使用打包缝合法。我们通过使用溃疡周围皮肤和NPWT的微创外科策略实现了PG的短期治疗。
