title: Post Surgical Pyoderma Gangrenosum in flap surgery: diagnostic clues and treatment recommendations.
abstract: BACKGROUND
  Post Surgical Pyoderma Gangrenosum (PSPG) is a neutrophilic dermatosis causing aseptic necrotic ulcerations within surgical sites. It is often misdiagnosed as infection or ischemia and worsened by the inappropriate treatment. Therefore diagnostic clues must be identified and awareness for PSPG raised.
  
  
  METHODS
  We present two cases of PSPG after flap surgery and a review of the literature.
  
  
  RESULTS
  Seventeen cases of PSPG after flap surgery were found. Fever, pain and redness are the most common initial symptoms. In 63%, lesions were on the flap and the adjacent skin. In 63%, the donor site is also involved. Time to diagnosis was nine days to four years. Frequent debridement (89%) and administration of antibiotics (74%) illustrate the misdiagnosis of infection or ischemia. PSPG in flap surgery seems to be less associated with underlying diseases, than other forms of Pyoderma Gangrenosum. Corticoids are the most commonly used treatment. Of the 19 cases, 10 experienced partial or total flap loss.
  
  
  CONCLUSIONS
  PSPG must be included in the differential diagnosis of postoperative wound problems. Recognizing the diagnostic clues can lead to early diagnosis and treatment with systemic immunotherapy. Associated diseases should be investigated and additional surgery can only be successful when associated with immunotherapy.
authors.affiliation: a Department of Plastic, Reconstructive and Aesthetic surgery , Ghent University Hospital , Ghent , Belgium.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dhooghe
authors.affiliation: b Department of Plastic Surgery , University of Palermo , Palermo , Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Oieni
authors.affiliation: c Department of Nephrology , Ghent University Hospital , Ghent , Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Peeters
authors.affiliation: a Department of Plastic, Reconstructive and Aesthetic surgery , Ghent University Hospital , Ghent , Belgium.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.affiliation: a Department of Plastic, Reconstructive and Aesthetic surgery , Ghent University Hospital , Ghent , Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roche
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000009:adverse effects*; D014945:Wound Healing / Q000502:physiology
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Post Surgical Pyoderma Gangrenosum; flap surgery