title: Postoperative pyoderma gangrenosum (PG): the Mayo Clinic experience of 20 years from 1994 through 2014.
abstract: BACKGROUND
  Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by the development of PG-type lesions within surgical sites.
  
  
  OBJECTIVE
  We sought to characterize postoperative PG as a distinct subtype of PG for earlier recognition and prevention of improper therapy.
  
  
  METHODS
  We conducted a retrospective chart review of patients with nonperistomal postoperative PG at Mayo Clinic from 1994 to 2014.x
  
  
  RESULTS
  Eighteen patients had postoperative PG with an average age of 58 years. Fifteen (83%) were female. Among patients with postoperative PG, 4 (22%) had an associated systemic disease traditionally associated with PG. Sites of postoperative PG included 7 breast (38%), 7 abdomen (38%), 1 back, 1 shoulder, 1 ankle, and 1 scrotum, witxxh breast reconstruction being the most common surgery. The average time to symptoms was 11 days. No patients had a fever. Eight (44%) had documented anemia and 5 (27%) had leukocytosis. Antibiotics and systemic corticosteroids were initiated in 10 (56%) and 14 (83%), respectively. Debridement was done in 11 (61%) patients.
  
  
  CONCLUSIONS
  Small sample size and retrospective study are limitations.
  
  
  CONCLUSIONS
  Postoperative PG is a rare surgical complication with predilection for the breast and abdomen of females and has less association with systemic disease than idiopathic PG. Early recognition may prevent unnecessary debridements and morbidity.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stanislav N
authors.initials: SN
authors.lastname: Tolkachjov
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Aodhnait S
authors.initials: AS
authors.lastname: Fahy
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: David A
authors.initials: DA
authors.lastname: Wetter
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Brough
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alina G
authors.initials: AG
authors.lastname: Bridges
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark D P
authors.initials: MD
authors.lastname: Davis
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rokea A
authors.initials: RA
authors.lastname: El-Azhary
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marian T
authors.initials: MT
authors.lastname: McEvoy
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. Electronic address: camilleri.michael1@mayo.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Camilleri
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015995:Prevalence; D017511:Pyoderma Gangrenosum / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000145:classification; D016896:Treatment Outcome
keywords: Cullen gangrene; breast; dehiscence; dermatitis ulcerosa; neutrophilic dermatosis; postoperative; postsurgical; pyoderma gangrenosum; wound infection