Talanker Michael M, Nye Jessica R, Mitchell David T, Freet Daniel J
Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
Eplasty. 2024 May 23;24:e31. eCollection 2024.
Postsurgical pyoderma gangrenosum (PSPG) is a highly uncommon and unpredictable wound healing complication. Rapid progression of ulcers at incisions can cause unfettered dehiscence. Most commonly, PSPG involves breast procedures; however, in this work, we detail a case of a patient who developed PSPG 10 days postoperatively after penile inversion vaginoplasty.
The patient in this case underwent a penile inversion vaginoplasty with orchiectomy in the standard fashion. She had no risk factors for PSPG. Following an uncomplicated hospital stay, the patient developed difficulty with pain control and increasing serous drainage on the 10th postoperative day. On readmission, the patient was found to have developed large, mildly purulent ulcers throughout the perineal wound edges. On exam under anesthesia, the neovaginal canal was found to be patent and intact. The dehisced portions of the incisions were left open and redressed with occlusive bismuth-petrolatum dressing. Dermatology was promptly consulted with suspicion for PSPG. The patient was started on an 18-day prednisone taper with cyclosporine, along with doxycycline and ciprofloxacin.
After 5 days of immunosuppressive treatment, the ulcers visibly converted to healthy granulation tissue and were no longer actively purulent. Following another washout, the dehisced wound edges were reapproximated. At follow-up, the patient had no evidence of PSPG recurrence and continued dilating on schedule. Our patient recovered from PSPG without further complications and a satisfactory aesthetic result.
This unique case highlights the importance of prompt dermatological consultation, immunosuppression, and avoidance of further pathergy in the setting of suspicion for PSPG.
术后坏疽性脓皮病（PSPG）是一种极为罕见且难以预测的伤口愈合并发症。切口处溃疡的快速进展可导致不受控制的裂开。PSPG最常累及乳房手术；然而，在本研究中，我们详细描述了一例患者，该患者在阴茎翻转阴道成形术后10天发生了PSPG。
该病例患者接受了标准方式的阴茎翻转阴道成形术及睾丸切除术。她没有PSPG的危险因素。在顺利的住院期间后，患者在术后第10天出现疼痛控制困难和浆液引流增加。再次入院时，发现患者会阴伤口边缘出现了大而轻度化脓的溃疡。在麻醉下检查时，发现新阴道管通畅且完整。切口裂开的部分保持开放，并用闭塞性铋凡士林敷料换药。怀疑为PSPG后立即咨询了皮肤科。患者开始使用泼尼松逐渐减量联合环孢素治疗18天，同时使用强力霉素和环丙沙星。
经过5天的免疫抑制治疗，溃疡明显转变为健康的肉芽组织，不再有明显脓性分泌物。经过再次清创后，裂开的伤口边缘重新对合。随访时，患者没有PSPG复发的迹象，并按计划继续进行扩张。我们的患者从PSPG中康复，没有进一步的并发症，并且获得了满意的美学效果。
这个独特的病例强调了在怀疑PSPG时及时进行皮肤科会诊、免疫抑制以及避免进一步激发的重要性。
