Abstract
BackgroundPyoderma gangrenosum is a rare ulcerating skin disease of unknown etiology, making its coincidence with orthopedic trauma a rare challenge. Patients are at risk of progression of the existing lesions and development of new lesions upon skin injury when surgical procedures are performed. To our knowledge, this is the first report in the literature of disease unrelated surgery during active pyoderma gangrenosum.Case presentationWe present a case of femoral neck fracture in a Caucasian patient with concurrent pyoderma gangrenosum localized in the axilla. Hemiarthroplasty was safely performed after disease activity was reduced with systemic corticosteroids. Tissue-protective wound closure was used together with perioperative corticosteroids and antibiotics. No signs of pyoderma gangrenosum developed at the surgical wound site, and the axillary lesions showed constant improvement until healing with scar tissue.ConclusionsIn our patient, the preoperative steroid treatment, perioperative antibiotics, and soft tissue protective surgical technique led to successful management of this rare coincidence.
Highlights
Pyoderma gangrenosum is a rare ulcerating skin disease of unknown etiology, making its coincidence with orthopedic trauma a rare challenge
The pathergy phenomenon describes the development of additional lesions or progression of existing ones during active pyoderma gangrenosum (PG) when skin integrity is interrupted [4]
Pathergy puts the patient at risk for complications, resulting in recommendations not to perform any surgery on PG lesions;
Summary
Due to the rarity of this constellation, recommendations based on high-level evidence cannot be made for orthopedic trauma treatment during active PG. In our patient’s case, the use of pre- and perioperative steroids, combined with perioperative antibiotics and a soft tissue protective surgical technique, provided a successful strategy for the treatment of this rare challenge in orthopedic trauma surgery. This case report should encourage other surgeons facing this challenge not to avoid necessary operative treatment and improve patients’ quality of life by adhering to the described principles. Total hip arthroplasty for femoral neck fracture with pyoderma gangrenosum patient: a case report. Split skin grafts in the treatment of pyoderma gangrenosum: a report of four cases. Pyoderma gangrenosum: an important differential diagnosis from wound infection: case report of a life threatening course. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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