title: Multimodal Therapy of Ulcers on the Dorsum of the Hand With Exposed Tendons Caused by Pyoderma Gangrenosum.
abstract: The authors present the case of a 54-year-old man with ulcers on the dorsal hand and forearm with exposed extensor tendons after he received misdiagnoses at 2 other hospitals, leading to deep soft tissue defects from multiple debridements. Due to the complicated nature of the wound, the ulcers did not heal under the systemic medication. After careful debridement, the defect was primarily closed with a collagen-glycosaminoglycan biodegradable matrix (Integra Matrix Wound Dressing, Integra LifeSciences, Plainsboro, NJ) on the dorsal hand and covered with a mesh graft 14 days later. Necrosis and superinfection over the index finger was treated again with systemic antibiotics and an unmeshed skin graft under a vacuum bandage with a mesh wound contact layer (Mepitel, Mölnlycke Health Care, Norcross, GA). The patient was satisfied with the functional and aesthetic outcome 1 month later when wounds were completely healed. The authors conclude that in cases where patients are living with pyoderma gangrenosum, even a challenging and complicated wound can be handled successfully with correct systemic immuno- suppression and appropriate soft tissue coverage.
authors.affiliation: Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leitsch
authors.affiliation: Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Konstantin Christoph
authors.initials: KC
authors.lastname: Koban
authors.affiliation: Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Pototschnig
authors.affiliation: Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Virginia
authors.initials: V
authors.lastname: Titze
authors.affiliation: Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Riccardo Enzo
authors.initials: RE
authors.lastname: Giunta
mesh_terms: D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013710:Tendons / Q000473:pathology*; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology / Q000628:therapy*; D014945:Wound Healing