title: Inpatient management of pyoderma gangrenosum: treatments, outcomes, and clinical implications.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic skin condition of unknown etiology. The disease continues to pose therapeutic challenges, with ongoing controversy regarding the role of surgery.
  
  
  METHODS
  A retrospective medical records review was conducted for 29 patients who were diagnosed and treated for PG at an Australian tertiary center over 10 years, from 1 January 2000 to 31 December 2010.
  
  
  RESULTS
  A total of 29 patients had a diagnosis of PG, with a total of 35 admissions. Nearly all patients had immunosuppressant therapy and 10 (35%) patients underwent surgery. Eight (28%) received hyperbaric oxygen therapy. Complications secondary to medical therapy occurred in 23 (66%) of admissions, with the commonest being poor blood sugar control in patients with diabetes (n = 6, 17%) and steroid-induced diabetes (n = 5, 14%). At discharge, 21 (72%) patients' ulcers had improved and there were 4 (14%) inpatient deaths. At 6 months, 3 of 10 cases with available follow-up showed complete ulcer healing. Most of the patients (n = 8, 80%) who underwent combined medical and surgical therapy had ulcers that had either completely healed or improved at 6 months after discharge. All 3 patients who underwent split skin grafting under immunosuppressive cover (with 2 having hyperbaric oxygen therapy) had no postoperative graft failure or pathergy.
  
  
  CONCLUSIONS
  Pyoderma gangrenosum remains a therapeutic challenge, with significant complications and morbidity from long-term medical treatment. Surgery should be considered in conjunction with combined hyperbaric and immunosuppressive therapy once the disease is quiescent, to reduce disease-related comorbidity as well as the consequent adverse effects of long-term immunosuppressant therapy.
authors.affiliation: From the Plastic, Hand & Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Miguel Suhady
authors.initials: MS
authors.lastname: Cabalag
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.forename: Shueh Wen
authors.initials: SW
authors.lastname: Lim
authors.forename: Frank Bruscino
authors.initials: FB
authors.lastname: Raiola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006931:Hyperbaric Oxygenation; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016038:Skin Transplantation; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents