chondroitin-sulfates and Pyoderma-Gangrenosum

A case of pyoderma gangrenosum progressively developing after bilateral mastopexy at the surgical site is described. The described case was successfully treated with corticosteroids, the application of the dermal regeneration template Integra and autologous skin grafts. This approach was able to save the patient's life and to generate a high-quality aesthetical outcome. The article reported the case, reviewed the literature of pyoderma gangrenosum related to mastopexy or augmentation mammoplasty and discussed the use of a dermal regeneration template to optimise aesthetical results after reconstructive surgery.

Topics: Adult; Alginates; Chondroitin Sulfates; Collagen; Drainage; Female; Humans; Mammaplasty; Pyoderma Gangrenosum; Skin Ulcer; Skin, Artificial; Surgical Wound Infection; Tomography, X-Ray Computed; Wound Healing

Reduction mammaplasty is a common procedure performed by plastic and reconstructive surgeons to relieve chronic back and neck pain associated with macromastia, with the added benefit of an improvement in the aesthetic contour of the ptotic breast. Complications related to this procedure are fortunately uncommon, but include hematoma, infection, and wound breakdown. The authors report an interesting case of reduction mammaplasty complicated postoperatively by pyoderma gangrenosum (PG), which is a rare inflammatory disorder leading to progressive skin necrosis. The destructive process, which involved both breast incisions, was managed successfully with immunosuppressive therapy and intensive wound care, followed by a novel method of coverage with a dermal regeneration template and subsequent epidermal autograft that led to stable coverage of the open wounds. PG is frequently misdiagnosed as a necrotizing infection, leading to improper debridement with exacerbation of the disease process. The mainstay of therapy for PG is still nonoperative and focuses on immunosuppressive medications and local wound care, which allows healing in most cases. However, there are a few indications for surgical intervention, including significantly large wounds that are refractory to medical management. It is important for plastic surgeons and other clinicians to be cognizant of this entity, as a delay in diagnosis and management of PG can lead to serious consequences, with considerable soft tissue loss and disfigurement of the breast.

Topics: Bandages; Chondroitin Sulfates; Collagen; Debridement; Female; Humans; Immunosuppressive Agents; Mammaplasty; Middle Aged; Pain, Postoperative; Postoperative Complications; Pyoderma Gangrenosum; Skin Transplantation