Pyoderma gangrenosum following autologous breast reconstruction

Abstract

Pyoderma gangrenosum (PG) is an uncommon disorder characterized by the development of painful cutaneous ulceration, commonly precipitated by dermal injury at surgical sites. It is a diagnostic challenge as it manifests as necrotizing wounds which are commonly misdiagnosed as postoperative wound infection or ischemia. We discuss the clinical features and histopathological findings that allow for rapid identification of PG following autologous breast reconstruction and suggest an algorithm to aid diagnosis.

Keywords: Pyoderma gangrenosum (PG); breast reconstruction; mastectomy; pathergy.

Figure 1

Photograph of right breast of patient presenting with pyoderma gangrenosum (PG) 5 days after bilateral breast reconstruction using deep inferior epigastric perforator flaps. Irregularly shaped necrotizing lesions with raised, violaceous edges, and sterile pyogenic exudate at multiple surgical sites indicated PG.

Figure 2

Photomicrograph illustrating a sharply demarcated area of epidermal ulceration with diffuse neutrophilic inflammatory infiltrate in the deep dermis associated with necrosis extending through the dermis to the subcutis (Haematoxylin & Eosin stain, 100×).