Stephan Ebrad1, Mathieu Severyns2, Ahmed Benzakour3, Benoit Roze4, Christian Derancourt5, Guillaume-Anthony Odri6, Jean-Louis Rouvillain3. 1. Orthopaedic and Traumatologic Department, Military Hospital Robert Picqué, 351 route de Toulouse, 33140, Villenave d'Ornon, France. 2. Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique. mathieu.severyns@hotmail.fr. 3. Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique. 4. Department of Infectiology, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique. 5. Department of Dermatology, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique. 6. Orthopaedic and Traumatologic Department, Lariboisière University Hospital, rue Ambroise Paré, 75010, Paris, France.
Abstract
INTRODUCTION: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by a painful ulceration mimicking infection of the operative site. To this day, there is still no general agreement on the medical and surgical treatment of PG. This systematic review of the literature aims to summarise recent studies about post-operative PG in orthopaedic surgery to improve its medical and surgical management. METHOD: In April 2017, we carried out an exhaustive review of the literature in MEDLINE, PubMed and Cochrane databases. Key words were pyoderma gangrenosum, orthopaedic surgery, and surgical wound infection. We identified 183 articles. After excluding articles reporting idiopathic PG, cases secondary to non-orthopaedic surgery, and cases about other subtypes of dermatosis, 30 studies were identified. We only included articles reporting PG after orthopaedic or trauma surgery. RESULTS: Thirty-one cases of PG have been reported, 58% (18) of which were in women, whose mean age was 56.5 years. Clinical signs were constant, the most frequently affected site was lower limbs [77.4% (24)] and delay of symptom onset was two to 17 days. Systemic corticosteroid therapy was systematic, polyvalent immunoglobulins were used in two cases and immunosuppressive drugs in one. Negative pressure therapy was used in seven cases and hyperbaric oxygen in three. DISCUSSION: Delayed diagnosis leads to one or more surgical revisions, which could have been avoided by using early and adapted medical treatment. Early onset of a painful and infected ulcer at the operating site in a patient at risk of PG is an indicator that dermatologist advice is recommended before surgical debridement. Surgical revision, outside the inflammatory phase and/or covered by a systemic corticosteroid therapy, does not lead to PG relapse. LEVEL OF EVIDENCE: IV: Systematic revue of the literature.
INTRODUCTION:Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by a painful ulceration mimicking infection of the operative site. To this day, there is still no general agreement on the medical and surgical treatment of PG. This systematic review of the literature aims to summarise recent studies about post-operative PG in orthopaedic surgery to improve its medical and surgical management. METHOD: In April 2017, we carried out an exhaustive review of the literature in MEDLINE, PubMed and Cochrane databases. Key words were pyoderma gangrenosum, orthopaedic surgery, and surgical wound infection. We identified 183 articles. After excluding articles reporting idiopathic PG, cases secondary to non-orthopaedic surgery, and cases about other subtypes of dermatosis, 30 studies were identified. We only included articles reporting PG after orthopaedic or trauma surgery. RESULTS: Thirty-one cases of PG have been reported, 58% (18) of which were in women, whose mean age was 56.5 years. Clinical signs were constant, the most frequently affected site was lower limbs [77.4% (24)] and delay of symptom onset was two to 17 days. Systemic corticosteroid therapy was systematic, polyvalent immunoglobulins were used in two cases and immunosuppressive drugs in one. Negative pressure therapy was used in seven cases and hyperbaric oxygen in three. DISCUSSION: Delayed diagnosis leads to one or more surgical revisions, which could have been avoided by using early and adapted medical treatment. Early onset of a painful and infected ulcer at the operating site in a patient at risk of PG is an indicator that dermatologist advice is recommended before surgical debridement. Surgical revision, outside the inflammatory phase and/or covered by a systemic corticosteroid therapy, does not lead to PG relapse. LEVEL OF EVIDENCE: IV: Systematic revue of the literature.
Authors: Maria Pichler; Lorenz Larcher; Michael Holzer; Gerald Exler; Tobias Thuile; Barbara Gatscher; Lukas Tappeiner; Jenny Deluca; Cinzia Carriere; Van Anh Nguyen; Verena Moosbrugger-Martinz; Matthias Schmuth; Georg F Klein; Klaus Eisendle Journal: J Am Acad Dermatol Date: 2016-04 Impact factor: 11.527
Authors: Michał Wasiak; Michał Ciszek; Ireneusz Babiak; Piotr Wasilewski; Paweł Łęgosz; Bartosz Kieroński; Paweł Małdyk Journal: Reumatologia Date: 2022-09-08