title: Pyoderma gangrenosum: a report of a rare complication after knee arthroplasty requiring muscle flap cover supplemented by negative pressure therapy and hyperbaric oxygen.
abstract: Pyoderma gangrenosum (PG) is rare ulcerating skin condition easily confused with wound infection following surgery. We report a complicated case of PG following knee arthroplasty where delayed diagnosis and repeated debridements lead to significant tissue loss. Successful reconstruction was achieved with a muscle flap, but subsequent reactivation of PG and superadded infection placed both the reconstruction and patient's life at risk. Prolonged combined use of negative pressure therapy (NPT), immunosuppression and hyperbaric oxygen (HBO) was successfully used to reduce the wound size, enhance wound granulation, promote re-epithelialisation, and provide pain relief. There is little or no published literature on these treatment modalities for the management of PG, with only one reported case using both NPT and HBO for PG (not following knee arthroplasty). More studies are necessary to determine the role of both modalities in the management of pathergy in large and complex wounds and the rare nature of this complication following knee arthroplasty explains the lack of evidence-based guidance. In conclusion, we suggest a surgical algorithm. This is the first report of PG following knee arthroplasty with the use of both NPT and HBO in order to achieve soft tissue coverage.
authors.affiliation: Department of Plastic Surgery, Royal Devon and Exeter Foundation Trust, Barrack Road, Exeter EX2 5DW, United Kingdom. danielhill@doctors.org.uk
authors.forename: D S
authors.initials: DS
authors.lastname: Hill
authors.forename: J K
authors.initials: JK
authors.lastname: O'Neill
authors.forename: A
authors.initials: A
authors.lastname: Toms
authors.forename: A M
authors.initials: AM
authors.lastname: Watts
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013524:Surgical Flaps
chemical_list: D007166:Immunosuppressive Agents