title: Pyoderma Gangrenosum After Breast Surgery: Diagnostic Pearls and Treatment Recommendations Based on a Systematic Literature Review.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is a rare cutaneous disorder that poses a diagnostic challenge in the postoperative period. A systematic literature review was performed to determine distinguishing characteristics of PG in the setting of breast surgery that can facilitate timely diagnosis and appropriate treatment.
  
  
  METHODS
  PubMed, EMBASE, Scopus, and Web of Science databases were systematically searched for articles with cases of PG occurring after breast surgery. Forty-three relevant articles, including 49 case reports, were identified.
  
  
  RESULTS
  PG manifested bilaterally in 30 of 34 cases (88%) in which bilateral surgery was performed. Abdominal wounds were present in 6 of 7 cases in which an abdominal donor site was used for breast reconstruction. Nipples were spared from wound involvement in 33 of 37 cases (89%) in which nipples were present after surgery. Presence of fever was noted in 27 cases (55%) and leukocytosis in 21 cases (43%). A total of 33 patients (67%) underwent wound debridement. Successful medical treatment most commonly involved steroids (41 cases, 84%) and cyclosporine (10 cases, 20%).
  
  
  CONCLUSIONS
  Pertinent clinical features were identified that may aid in timely diagnosis and treatment of PG after breast surgery. Appearance of discrete wounds involving multiple surgical sites that surround but spare the nipples should raise suspicion for PG rather than infection or ischemia, even with concomitant fever and leukocytosis. Wound debridement should be minimized and skin grafting considered only after medical therapy is initiated. Cognizance of these features may enable prompt therapeutic intervention that minimizes morbidity and improves outcomes.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Sami H
authors.initials: SH
authors.lastname: Tuffaha
authors.forename: Karim A
authors.initials: KA
authors.lastname: Sarhane
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.forename: Sashank K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Saïd C
authors.initials: SC
authors.lastname: Azoury
authors.forename: Stella
authors.initials: S
authors.lastname: Seal
authors.forename: Damon S
authors.initials: DS
authors.lastname: Cooney
authors.forename: Steven C
authors.initials: SC
authors.lastname: Bonawitz
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D011183:Postoperative Complications / Q000175:diagnosis*; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000209:etiology