Pyoderma gangrenosum after breast surgery: a systematic review

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Denis C. Ehrl, Paul I. Heidekrueger, P. Niclas Broer
BackgroundPost-surgical pyoderma gangrenosum (PSPG) is a rare inflammatory skin disorder of unknown etiology. Given its similar presentation to wound infection and lack of reliable diagnostic tests as well as pathognonic clinical features, PSPG is difficult to diagnose. Aim of this review was to identify factors contributing to PSPG in order to aid with timely diagnosis and appropriate therapy.MethodsA systematic literature review was performed following PRISMA guidelines, focusing on PSPG after reconstructive and aesthetic breast surgery. The online databases PubMed, Medline, EMBASE, Scopus, and Cochrane were used and additionally a Google© search was performed.ResultsA total of 68 articles describing 87 cases of PSPG following aesthetic and reconstructive breast surgery were found. The majority of PSPG (44%) occurred after breast reduction surgery and microsurgical breast reconstruction (16%). Most common associated conditions were malignancies in 37%, and autoimmune deficiencies in 17%. Microbiological examinations were found to be negative in 90%. The median time from initial presentation with symptoms to correct diagnosis of PG lasted on average 12.5 days, with unsuccessful first-line therapy on average for 20.0 days. After the diagnosis of PG, medical therapy most commonly involved steroids in 84% and/or Cyclosporine A in 22% of the cases. On average, the duration of this therapy lasted 4.7 months.ConclusionPSPG remains challenging to diagnose. However, according to the presented review, several distinct clinical signs in combination with lack of treatment response should prompt further investigation in order to promote timely diagnosis and correct treatment of this potentially debilitating disease.



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