Subscribe to RSS
DOI: 10.1055/s-2005-915205
Simultaneous Bilateral Microvascular Tissue Transfer for Soft-Tissue Defects of the Lower Extremities in Pyoderma Gangrenosum
Publication History
Accepted: April 13, 2005
Publication Date:
12 August 2005 (online)
![](https://www.thieme-connect.de/media/jrm/200506/lookinside/thumbnails/10.1055-s-2005-915205-1.jpg)
ABSTRACT
Pyoderma gangrenosum is a necrotizing skin disease of unknown etiology. The lesions are painful and occur mostly on the lower extremities, either single or multiple, but can appear in any region of the body. The authors report a case of pyoderma gangrenosum involving bilateral skin lesions over the anterior surface of the legs in a 13-year-old male patient. The lesions presented with ulcerative colitis, which is one of the most commonly associated diseases of pyoderma gangrenosum. After examination, systemic immunosuppressive treatment was administered and the progression of the disease was controlled. The lesions were treated with the simultaneous application of two free anterolateral thigh fasciocutaneous flaps after radical debridement. The procedure was successfully performed and no recurrence was observed. Although microvascular free tissue transfer cannot be performed in a standard fashion in pyoderma gangrenosum cases because of the risk of pathergy response, it should be considered as a surgical option in selected cases, otherwise difficult to manage, with the simultaneous application of appropriate systemic medical treatment.
KEYWORDS
Pyoderma gangrenosum - microvascular tissue transfer
REFERENCES
- 1 Kaddoura I L, Amm C. A rationale adjuvant surgical intervention in pyoderma gangrenosum. Ann Plast Surg. 2001; 46 23-28
- 2 Rozen S M, Nahabedian M Y, Manson P N. Management strategies for pyoderma gangrenosum: case studies and review of literature. Ann Plast Surg. 2001; 47 310-315
- 3 Long C C, Jessop J, Young M, Holt P JA. Minimizing the risk of post-operative pyoderma gangrenosum. Br J Dermatol. 1992; 127 45-48
- 4 Powell F C, Su W P, Perry H O. Pyoderma gangrenosum: classification and management. J Am Acad Dermatol. 1996; 34 395-407
- 5 Chow R K, Ho V C. Treatment of pyoderma gangrenosum. J Am Acad Dermatol. 1996; 34 1047-1060
- 6 Brunsting L A, Goeckerman W H, O'Leary P A. Pyoderma (ecthyma) gangrenosum-clinical and experimental observation in five cases occurring in adults. Arch Dermatol. 1930; 22 655-680
- 7 Jain A, Nanchahl J, Bunker C. Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap-a lesson to learn. Br J Plast Surg. 2000; 53 437-439
- 8 Gudi V S, Julian C, Bowers P W. Pyoderma gangrenosum complicating bilateral mammaplasty. Br J Plast Surg. 2000; 53 440-441
- 9 MacKenzie D, Moiemen N, Frame J D. Pyoderma gangrenosum following breast reconstruction. 2000; 53 441-443
- 10 Lifchez S D, Larson D L. Pyoderma gangrenosum after reduction mammaplasty in an otherwise healthy patient. Ann Plast Surg. 2002; 49 410-413
- 11 Jejurikar S S, Kuzon W M, Cederna P S. Recurrence of pyoderma gangrenosum within a chronic wound following microvascular free-tissue transfer. J Reconstr Microsurg. 2000; 16 535-539
- 12 Classen D A, Thomson C. Free flap coverage of pyoderma gangrenosum leg ulcers. J Cutan Med Surg. 2002; 6 327-331
- 13 Calderon W, Chang N, Mathes S J. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg. 1986; 77 785-794
- 14 Mimoun M, Hilligot P, Baux S. The nutrient flap: a new concept of the role of the free flap and application to salvage of arterio-sclerotic lower limbs. Plast Reconstr Surg. 1989; 84 458-467
- 15 Serletti J M, Deuber M A, Guidera P M et al.. Atherosclerosis of the lower extremity and free tissue reconstruction for limb salvage. Plast Reconstr Surg. 1995; 96 1136-1144
Ömer ÖzkanM.D.
Akdeniz Üniversitesi Hastanesi, Plastik ve Rekonstrüktif Cerrahi Anabilim Dali
B Blok kat 5, Antalya, Turkey