Bombardelli Joao, Parikh Janak, Morkuzu Suat, Spiegel Aldona J
Department of Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, United States.
Department of Surgery, Division of Plastic Surgery - Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, United States.
JPRAS Open. 2022 May 16;33:42-46. doi: 10.1016/j.jpra.2022.05.009. eCollection 2022 Sep.
Pyoderma gangrenosum (PG) is a skin disorder characterized by painful, enlarging necrotic ulcers with bluish borders surrounded by advancing zones of erythema. The key histologic feature is neutrophilic infiltration of the superficial and deep layers of the dermis and the absence of microorganisms. Although rare and associated with autoimmune diseases such as rheumatoid arthritis, ulcerative colitis and Crohn's disease, the diagnosis is commonly missed at presentation and patients are often treated for infection with antibiotics and surgical debridement. We present a case of PG in a 51 year-old woman after a deep inferior epigastric perforator (DIEP) flap for breast reconstruction who was promptly diagnosed and treated with steroids with appropriate response. Our case highlights the importance of rapid diagnosis and treatment of this disease to avoid incorrect management including surgical debridement, which can exacerbate the disease and increase its morbidity.
坏疽性脓皮病（PG）是一种皮肤疾病，其特征为疼痛性、不断扩大的坏死性溃疡，边界呈蓝色，周围有进行性红斑区。关键的组织学特征是真皮浅层和深层的中性粒细胞浸润且无微生物。尽管罕见且与类风湿性关节炎、溃疡性结肠炎和克罗恩病等自身免疫性疾病相关，但在就诊时通常会漏诊，患者常接受抗生素治疗感染及手术清创。我们报告一例51岁女性在进行腹壁下深动脉穿支（DIEP）皮瓣乳房重建术后发生PG的病例，该患者经及时诊断并接受类固醇治疗后反应良好。我们的病例强调了快速诊断和治疗该疾病的重要性，以避免包括手术清创在内的不当处理，手术清创可能会使病情加重并增加其发病率。
