Pyoderma gangrenosum after breast surgery: A systematic review

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 71; no. 7; pp. 1023 - 1032
• Main Authors: Ehrl, Denis C., Heidekrueger, Paul I., Broer, P. Niclas
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2018
• Subjects: Autoimmune Diseases - complications; Breast Neoplasms - complications; Breast Neoplasms - surgery; Cyclosporine - therapeutic use; Dermatologic Agents - therapeutic use; Diagnostic Errors; Female; Fever - etiology; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Leukocytosis - etiology; Mammaplasty; Mastectomy; Post-surgical pyoderma gangrenosum breast; Postoperative Complications; Pyoderma Gangrenosum - diagnosis; Pyoderma Gangrenosum - therapy; Pyoderma gangrenosum breast; Pyoderma gangrenosum breast reconstruction; Pyoderma gangrenosum breast surgery; Skin Transplantation; Surgical Wound Infection - diagnosis; Time-to-Treatment; Pyoderma gangrenosum breast reconstruction; Post-surgical pyoderma gangrenosum breast; Pyoderma gangrenosum breast; Pyoderma gangrenosum breast surgery
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2018.03.013

Post-surgical pyoderma gangrenosum (PSPG) is a rare inflammatory skin disorder of unknown aetiology. Given its similar presentation to wound infection and lack of reliable diagnostic tests as well as pathognomonic clinical features, PSPG is difficult to diagnose. The aim of this review was to identify factors contributing to PSPG to aid with timely diagnosis and appropriate therapy. A systematic literature review was performed by 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. A 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%). The most common associated conditions were malignancies in 37% and autoimmune deficiencies in 17%. Microbiological examinations were found to have a negative result in 90%. The median time from initial presentation with symptoms to correct diagnosis of PG was 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 was 4.7 months. The diagnosis of PSPG remains a challenging issue. However, according to the presented review, several distinct clinical signs in combination with lack of treatment response should prompt further investigation to promote timely diagnosis and correct treatment of this potentially debilitating disease.