Domingue Grayson, Cox Kyle, Fox Jake A, Atkins Austin, Haleem Amgad M, Brewer Jeffrey
Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Mobile, Alabama, United States.
J Orthop Case Rep. 2023 May;13(5):72-75. doi: 10.13107/jocr.2023.v13.i05.3652.
Pyoderma gangrenosum (PG) is a skin condition driven by neutrophil activation resulting in painful ulcers with undermining borders and surrounding erythema. This can be seen, although rarely, post-traumatically. It has been reported in the setting of orthopedic trauma with only 31 cases reported in English literature after orthopedic surgery.
A 20-year-old Caucasian female presented with multisystem trauma and multiple orthopedic injuries following motor vehicle collision. After fixation of orthopedic injuries, within 1 week post-operatively, the patient began to show signs of wound breakdown characterized by apparent purulence and skin necrosis at surgical sites and subsequently at additional non-surgical sites on bilateral lower extremities. After the failure of aggressive debridement and negative cultures, skin biopsy revealed post-traumatic PG. After diagnosis and treatment with corticosteroid therapy, the patient promptly recovered with the resolution of systemic and musculoskeletal manifestations.
Post-traumatic PG should be considered a potential etiology in non-healing wounds with negative cultures. A low threshold for skin biopsy and interdisciplinary involvement should be maintained to expedite diagnosis and guide treatment.
坏疽性脓皮病（PG）是一种由中性粒细胞活化引起的皮肤疾病，可导致疼痛性溃疡，边缘呈潜行性，周围有红斑。这种情况虽然罕见，但可在创伤后出现。在骨科创伤的情况下已有报道，骨科手术后英文文献中仅报道了31例。
一名20岁的白种女性在机动车碰撞后出现多系统创伤和多处骨科损伤。骨科损伤固定后，术后1周内，患者开始出现伤口裂开的迹象，表现为手术部位明显化脓和皮肤坏死，随后双侧下肢的其他非手术部位也出现这种情况。在积极清创和培养结果为阴性后，皮肤活检显示为创伤后PG。经皮质类固醇治疗诊断和治疗后，患者全身及肌肉骨骼症状消退，迅速康复。
创伤后PG应被视为培养结果为阴性的不愈合伤口的潜在病因。应保持较低的皮肤活检阈值并进行多学科参与，以加快诊断并指导治疗。
