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08.11.2017 | Review Article

Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature

verfasst von: Stephan Ebrad, Mathieu Severyns, Ahmed Benzakour, Benoit Roze, Christian Derancourt, Guillaume-Anthony Odri, Jean-Louis Rouvillain

Erschienen in: International Orthopaedics | Ausgabe 2/2018

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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.

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Titel: Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature
verfasst von: Stephan Ebrad
Mathieu Severyns
Ahmed Benzakour
Benoit Roze
Christian Derancourt
Guillaume-Anthony Odri
Jean-Louis Rouvillain
Publikationsdatum: 08.11.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 2/2018
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3672-2

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Abstract

Introduction

Method

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Discussion

Level of evidence

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