Management of an unfortunate triad after breast reconstruction: pyoderma gangrenosum, full-thickness chest wall defect and Acinetobacter Baumannii Infection.
If diagnosed late, post-surgical pyoderma gangrenosum (PSPG) is a rare, tricky and potentially life-threatening complication. Once diagnosed, immunosuppressive agents may provoke further complications. Well-intentioned extensive serial debridement may cause deep skin and soft-tissue defects, requiring skin grafting and possible flap surgery. The combination of necessary immunosuppressive treatment, protracted hospital stay and broad-spectrum systemic antimicrobial therapy may encourage serious acquired multidrug resistance (MDR). We report an unfortunate triad following breast reconstruction of PSPG, full-thickness chest wall defect and MDR with Acinetobacter baumannii infection. Interdisciplinary treatment using free flap surgery and negative-pressure wound therapy with instillation therapy (V.A.C.Instill(R) Wound Therapy) enabled survival and complete wound closure.
Division of Plastic Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. michael.schintler@meduni-graz.at
Michael V
MV
Schintler
Martin
M
Grohmann
Claudio
C
Donia
Elisabeth
E
Aberer
Erwin
E
Scharnagl
D000151:Acinetobacter Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D040981:Acinetobacter baumannii / Q000187:drug effects; D003428:Cross Infection / Q000209:etiology / Q000628:therapy; D003646:Debridement / Q000009:adverse effects; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013524:Surgical Flaps / Q000009:adverse effects; D035441:Thoracic Wall