Pyoderma gangrenosum following an unplanned caesarean section: a patient revisited

Abstract

A 35-year-old woman was referred urgently to the dermatology department because of significant wound breakdown 3 weeks following an emergency caesarean section. Examination revealed a full thickness, undermined ulcer spanning the width of the patient's caesarean scar, exposing the patient's uterus. Clinical appearances were consistent with pyoderma gangrenosum. The patient has a history of complicated pyoderma gangrenosum, having undergone skin grafts 14 years prior, for ulcers on her lower legs. That episode was the subject of a case report, published in the BMJ, in 2007. On this occasion, the patient was treated with oral corticosteroids, and ciclosporin based on its efficacy during her previous episode, which in conjunction with negative pressure wound therapy, resulted in complete re-epithelialisation of her ulcer within 6 months.

Keywords: dermatology; obstetrics and gynaecology; wound care.

Figure 1

The patient’s abdominal wound, on presentation to the dermatology department.

Figure 2

Negative pressure wound therapy setup.

Figure 3

The patient’s abdominal wound after 3 months of negative pressure wound therapy

Figure 4

The patient’s abdominal wound, at approximately 6 months