Surgery for Pyodermia fistulans sinifica to circumvent heart transplantation (Case Report).
BACKGROUND
Pyoderma fistulans sinifica (PFS) is a rare chronic cutaneous and subcutaneous infectious disease and is associated with major physical and psychological morbidity. In this article, we present the case of a young patient affected by severe PFS, who concomitantly suffered severe left-sided cardiac insufficiency and was considered for cardiac transplantation. By radical debridement and skin grafting of all areas affected by PFS, the patient's overall condition rapidly improved and was correlated with a significant and measurable improvement of cardiac function.


METHODS
Plastic surgery was consulted on a 32-year-old male by the cardiac intensive care unit with a 2-year history of recurrent pyogenic skin infections of the inguinal and axillary regions. He presented with a dilated cardiomyopathy with an ejection fraction (EF) of 15%, first-degree pulmonary insufficiency and second-degree mitral insufficiency and an overlying myocarditis leading to the picture of severe cardiac insufficiency, making him eligible for heart transplantation. The intention was to eradicate the chronic infective wounds as a preparative prior to cardiac transplantation. Radical debridement of the involved areas and coverage with split-thickness skin grafts took place and led to a significant improvement of the patient's condition. Echocardiography revealed a 266.67% improvement of the EF to 40%. Cardiac transplantation became unwarranted. At 1.5 years postoperatively, the patient is free of disease and has a normal cardiac function.


CONCLUSIONS
PFS is characterised in its early stages by local inflammation with beginning ulceration and can be managed conservatively. In advanced stages, as illustrated in this report, PFS must be considered as the potential source of systemic inflammatory process with significant alterations in multiple-organ systems and must be treated aggressively.
Penna
V
V
Department of Plastic and Hand Surgery, University Medical Centre Freiburg (UMCF), Hugstetter Strasse 55, 79106 Freiburg, Germany. vincenzo.penna@uniklinik-freiburg.de
Dowlatshahi
S
S
Padron
N Torio
NT
Stark
G B
GB
Bannasch
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H
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D017577:Cutaneous Fistula / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003646:Debridement / Q000379:methods; D005500:Follow-Up Studies; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods; D017497:Hidradenitis Suppurativa / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011711:Pyoderma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D000900:Anti-Bacterial Agents