Use of negative pressure wound therapy to successfully treat postoperative pyoderma gangrenosum following laparoscopic surgery: a case report.

INTRODUCTION

PG is a rare neutrophilic skin disorder with a variable clinical presentation, and diagnosis is often delayed. PPG typically presents as a necrotic ulcerative lesion with surrounding erythema and is often mistaken for a surgical site infection. Delayed diagnosis can lead to extensive morbidity and a prolonged healing time.

CASE REPORT

A 75-year-old male presented to the emergency department 2 weeks following laparoscopic appendectomy for acute appendicitis. He had fever and a suspected surgical site infection. Antibiotic treatment was initiated, and debridement was performed. Eventually, the diagnosis of PPG was made. Immunosuppressive therapy combined with NPWT was initiated. Complete wound healing was achieved 2 months after admission.

CONCLUSIONS

Surgeons should have a high index of suspicion of underlying skin disorders when presumed postoperative wound infections do not respond to aggressive antibiotic and surgical treatment. Early multidisciplinary consultation should be considered. In the case of PPG, the authors of the present report advise early initiation of systemic immunosuppressive therapy combined with atraumatic wound care. NPWT should be considered as appropriate. Surgical debridement may be indicated in the setting of extensive necrosis or uncontrollable superinfection.