Novel Use of Wound Matrix in Mastopexy Complicated by Pyoderma Gangrenosum

Abstract

Pyoderma gangrenosum (PG) is a relatively uncommon inflammatory skin disorder that is characterized by rapid onset, ulcerative lesions, and often triggered by trauma or surgery. Although rare, PG of the breast has been well described in the plastic surgery literature, most often reported following breast reductions and reconstructions. The authors present a case of PG that developed in a 56-year-old patient, with a history of essential thrombocytosis, following mastopexy. Her significant full-thickness skin loss was successfully treated with steroids and then reconstructed via serial applications of porcine placental extracellular matrix grafts. Her wounds were completely healed in 3.5 months for the left, and 5 months for the right breast. To the best of the author's knowledge, this is the first published case in which placental grafts have been successfully used to reconstruct pyoderma wounds of the breast. Given their advantageous scarring and lack of donor-site morbidity, placental grafts should be considered for all breast surgery patients afflicted by PG.

Figure 1.

Initial appearance of the 56-year-old female patient's breasts on postoperative day 8.

Figure 2.

A 56-year-old female's (A) right and (B) left breasts following initial debridement, 10 days after mastopexy.

Figure 3.

A 56-year-old female's (A) right and (B) left breasts following full demarcation, 6.5 weeks after mastopexy.

Figure 4.

Progression of a 56-year-old female's breasts as follows: (A) right breast after 1 month of graft applications, (B) left breast after 1 month of graft applications, (C) right breast after 2 months of graft applications, (D) left breast after 2 months of graft applications, (E) right breast after 3.5 months of graft applications, and (F) left breast after 3.5 months of graft applications.

Figure 5.

Healed breasts of a 56-year-old female after 5 months of graft applications.

Figure 6.

Healed breasts of a 56-year-old female after 5 months of graft applications shown at (A) left oblique, (B) left, (C) right oblique, and (D) right views.