Postsurgical Pyoderma Gangrenosum Research Articles

Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review.

Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: "pyoderma gangrenosum" and "surgery." This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.

Pyoderma gangrenosum with severe systemic features, after augmentation mammoplasty

AbstractWe report a rare life‐threatening presentation of postsurgical pyoderma gangrenosum (PG) after augmentation mammoplasty in a 32‐year‐old woman. Six days after surgery, the patient presented with fever and erythema at surgical wounds. In view of a suspected postsurgical infection, the patient was first treated with antibiotics and removal of breast protheses. In spite of this treatment, in a few days the patient developed a state of shock with multiorgan failure. The antibiotic coverage was broadened several times and multiple extensive surgical debridement with resection of the mammary glands were performed but did not improve the clinical situation. Twelve days after admission, the diagnosis of PG with systemic features was suspected and clinical improvement was observed within 24 h of methylprednisolone administration. PG can mimic the cutaneous and systemic features of necrotizing wound infection of surgical site. Biopsy and culture are critical to differentiating necrotizing neutrophilic dermatosis from necrotizing infection. The diagnosis of this less common form of PG is challenging and this case highlights how the frequent misdiagnosis with infection may result in ineffective antibiotic treatment and how the unnecessary surgical debridement may prolong and exacerbate the condition.

439 A Rare Cause of Flap Loss and Wound Dehiscence After Immediate DIEP Flap Breast Reconstruction - Raising Awareness of Pyoderma Gangrenosum (Case Report & Literature Review)

Abstract Aim To raise awareness of post-surgical pyoderma gangrenosum (PSPG) as an uncommon but potentially devastating sequelae of free-flap breast reconstruction. Our patient developed PSPG ∼1 week after a DIEP flap. Symptoms and signs were of wound infection, and she was managed as such. Histology and MDT confirmed diagnosis 3 weeks later. Once appropriate treatment was commenced, a good response was seen. However, diagnostic delay meant multiple procedures, antibiotics, and a suboptimal outcome requiring secondary reconstruction. Method Retrospective case report compiled using CARE guidance. Literature review using PubMed/Science Direct. Results PSPG in free-flap breast reconstruction is rare (∼20 reported cases). Symptoms occur 4 days to 6 weeks post-op. Deteriorating wounds mimicking infection/ischaemia are classical, often associated with ulceration, irregular, raised borders. Positive wound cultures and late evolution of classic signs clouded diagnosis in our case. Our patient had several microbiological, haematological, and radiological investigations in the first 3 weeks; most were equivocal and, in retrospect, likely unhelpful. Conclusions PSPG should be considered when post-op wound infection is suspected in cases with non-classical signs. Given its potentially devastating effect on free-flap reconstruction, we recommend PSPG be discussed as a rare but serious complication during consent. A high index of suspicion is needed to avoid unnecessary antimicrobials, detrimental surgical procedures, and initiate appropriate medical management in a timely fashion. Good outcomes can be obtained if recognised early.

DS25 Postsurgical pyoderma gangrenosum successfully managed with skin grafting in a breastfeeding postpartum patient

Abstract A 32-year-old woman who was breastfeeding presented 7 weeks postpartum with right breast pain, swelling and erythema. A clinical diagnosis of mastitis was confirmed on ultrasound, and she was started on intravenous (IV) flucloxacillin. Initial cultures grew methicillin-sensitive Staphylococcus aureus, and clindamycin was added. She failed to improve and 6 days later an abscess was incised and drained. A vacuum-assisted closure (VAC) dressing was placed over the wound postoperatively. Over the following 3 days, she deteriorated clinically with markedly increased pain, spiking temperatures and malaise. Linezolid and metronidazole were added. On return to theatre for wound review, she had an 18 cm × 10 cm deep necrotic ulcer with purulent discharge, sparing the nipple. The breast surgeon’s concern was that of necrotizing fasciitis, and an immediate wider debridement was performed, removing all breast skin except for the nipple. Dermatology was then consulted, and a diagnosis of pyoderma gangrenosum (PG) was made. The patient was commenced on IV methylprednisolone 1 g daily for 3 days. Her temperature normalized immediately, and her C-reactive protein dropped from 141 to 27 mg L−1 in 24 h. The previously rolled, violaceous wound edges settled with no further progression. Following 3 days of steroid, ciclosporin 5 mg kg−1 daily was commenced. The right breast continued to lactate, and the very large defect now present was anticipated to pose many difficulties for the young mother. Five weeks after the initial presentation, and following multidisciplinary discussion, a biodegradable temporizing matrix (BTM; NovoSorb®) was applied, under continued dermatologist-supervised immunosuppression. The BTM took with good effect. Two weeks later, a split-thickness skin graft was applied to the BTM. The skin grafting took successfully, with no reactivation of PG postoperatively. Three months postgrafting, the patient is now being weaned off ciclosporin and remains well. Postpartum PG is rare and is predominantly reported at the site of caesarean section incision. Surgery is typically discouraged in PG owing to the risk of disease reactivation. However, surgery in this case was considered appropriate due to the rapid disease control with immunosuppression, the extent of ulceration, the expected prolonged healing period requiring exposure to the toxicity of ciclosporin and the avoidance of cribriform scarring often seen with PG. This case highlights how PG should always be considered in postpartum patients presenting with rapidly progressing, nonhealing ulcers. It also shows that, despite our usual treatment practices, in certain cases, early surgical intervention can be considered alongside ongoing immunosuppression resulting in positive patient outcomes.

The Management of Postsurgical Pyoderma Gangrenosum following Breast Surgery.

Background:Postsurgical pyoderma gangrenosum is a rare condition characterized by ulcerative lesion development at surgical sites. It is frequently misdiagnosed as infection and mismanaged with surgical debridement, which only worsens the condition. Achieving the correct diagnosis is crucial to delivering the appropriate medical therapy. This article presents four clinical cases of postsurgical pyoderma gangrenosum in breast surgery patients, and proposes a work-up schematic to aid in its diagnosis based on literature review and author experience.Methods:Four patients who developed postsurgical pyoderma gangrenosum following breast surgery were identified by chart review at our institution.Results:The cases include two breast reduction patients, an abdominally based breast reconstruction patient, and a breast augmentation patient. The time to diagnosis and treatment varied greatly between the patients, with diagnosis achieved as early as 13 days postoperatively to as late as one year postoperatively. Two of the four patients were initially mismanaged with surgical debridement, and all patients were treated with at least one course of antibiotics for a misdiagnosis of surgical site infection before they were correctly diagnosed.Conclusions:Postsurgical pyoderma gangrenosum is a rare, ulcerative condition that is difficult to diagnose and often mismanaged with surgical debridement. Diagnosis requires a high clinical suspicion and should be considered in patients with ulcerative lesions resistant to antibiotic therapy, in patients who have bilateral lesions with NAC sparring, and in those with systemic inflammatory conditions. Diagnosis is usually delayed, so it is imperative that surgeons keep this diagnosis in mind when treating breast patients with postsurgical wounds.

Management of Postsurgical Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Role for a Dermal Regeneration Template

Pyoderma gangrenosum (PG) is a relatively uncommon necrotizing and ulcerative cutaneous disorder. It is often associated with a systemic inflammatory disease but may also present following trauma to the skin due to pathergy. Given its rare occurrence and nonspecific histology, PG is primarily a diagnosis of exclusion, which often results in delayed treatment. Very few cases of PG following autologous breast reconstruction have been reported in the literature, particularly in the absence of systemic disease. Presented is the case of a 62-year-old female with a history of ductal carcinoma in situ who underwent a left breast mastectomy with immediate deep inferior epigastric perforator flap breast reconstruction complicated by fever and leukocytosis as well as erythema, edema, and bullae involving the mastectomy flaps. Initially, necrotizing soft-tissue infection was suspected, and 2 debridements were performed. A diagnosis of PG was made on postoperative day 7, and the patient responded favorably to high-dose prednisone. Reconstruction was performed with a bilayer wound matrix and delayed skin grafting. Despite significant loss of mastectomy skin flap, the free flap was preserved. Although PG is a rare complication, it should be considered in the differential diagnosis for patients with atypical presentation of infection following breast reconstruction, even in the absence of systemic inflammatory disease. Early diagnosis and multidisciplinary management may prevent unnecessary surgical intervention and enable flap preservation. Furthermore, bilayer wound matrix placement may be useful as an intermediate reconstruction to determine if it is safe to proceed with skin grafting to avoid further pathergy. The findings in this case suggest that final reconstruction may be safely performed sooner than noted in the literature.

Post-surgical pyoderma gangrenosum as a cause of unexplained wound breakdown.

Post-surgical pyoderma gangrenosum as a cause of unexplained wound breakdown.

Post-surgical pyoderma gangrenosum following electrosurgery and elliptical excision: A rare disease following common procedures

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis with an estimated annual incidence of 3–10 cases per million per year. Post-surgical pyoderma gangrenosum (PSPG) refers to the development of pyoderma gangrenosum at surgical sites in the postoperative period. A 55-year-old female was admitted with two acute and enlarging painful breast ulcerations resistant to antibiotic treatment following surgical resection and electrofulguration by her dermatologist. Multiple wound cultures were negative. A skin biopsy was consistent with PG and the wounds improved after adequate oral immunosuppressive therapy. A high index of suspicion, exclusion of other differential diagnoses, and previous experience with this disease ensured an early diagnosis, prevented injury to life and unnecessary debridement, and resulted in an excellent outcome for the patient.

Postsurgical Pyoderma Gangrenosum After Breast Surgery: A Plea for Early Suspicion, Diagnosis, and Treatment.

Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder. Although PG is a diagnosis of exclusion, prompt recognition is essential to attain the desired outcomes. From an aesthetic standpoint, this is especially critical with breast involvement and other body segments. We present a consecutive case series of four patients who developed PG following breast surgery and responded to early intervention. A chart review identified four patients who were identified as having developed PG after either aesthetic or reconstructive breast surgery. Their histories, associated risk factors, diagnosis, course of treatment, and results were documented. The PubMed database was then searched to find the literature for comparison. The average time from surgery to the onset of symptoms was 11days, and the average time from the onset of symptoms to the correct diagnosis of PG was 41days. The average length of steroid therapy was 25days. The average time from the initiation of steroids to complete wound closure was 51days. The average time from the onset of symptoms to complete wound closure bilaterally was 87days. All wounds healed with conservative management. Postsurgical PG is a rare but recognized cause of postoperative wound breakdown in patients who have undergone plastic surgery procedures to the breast. Early recognition and treatment can facilitate prompt reversal of the inflammatory process leading to complete wound healing and limitation of the morbidity that can be associated with the disease. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report

Pyoderma gangrenosum (PG) is a rare dermatologic condition manifesting as sterile, rapidly progressing painful skin ulcerations. It is commonly associated with autoimmune disorders such as inflammatory bowel disease. This case report illustrates a severe case of post-surgical pyoderma gangrenosum (PSPG) following bilateral deep inferior epigastric perforator flap breast reconstruction in a 56-year-old Caucasian woman. Factors delaying diagnosis included negative personal/family history of inflammatory disorders and a clinical presentation more suggestive of breast cellulitis. Refractory antibiotic therapy, subsequent ulceration at multiple breast and abdominal incisions, and pathergic response to tissue biopsy supported an eventual clinical diagnosis of PSPG, 12 days postoperatively, despite equivocal histopathologic findings. Initiation of intravenous immunoglobulin, prednisone therapy, local wound care, and avoidance of debridement led to a full resolution by 5 months postoperatively. This study raises awareness for PSPG and highlights the importance of early recognition and urgent dermatology consultation to expedite optimal treatment and minimize subsequent fat necrosis.

Post-surgical Pyoderma Gangrenosum after Cesarean Section in A Patient with Behçet's Disease

Post-surgical Pyoderma Gangrenosum after Cesarean Section in A Patient with Behçet's Disease

Necrotising fasciitis or pyoderma gangrenosum: A fatal dilemma.

Necrotising fasciitis (NF) is mostly a polymicrobial, severe soft tissue infection that progresses rapidly, penetrating through the subcutaneous tissue to the fascial planes and the muscles. The pyoderma gangrenosum (PG), on the other hand, is a rare, rapidly progressive (except for the post-surgical PG), autoinflammatory ulcerative skin and soft tissue condition. In this study, we tried to emphasise the importance of diagnosing the NF as well as the PG. Although these two clinical presentations have some standard features, awareness of different symptoms in detail affect the outcome. Any surgical discipline can face NF or PG and, therefore, should be aware of them to decrease the mortality rate. Forty-five patients with NF and PG who were treated between January 2008 and October 2018 were included in the study and evaluated retrospectively for age, sex, localisation, onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, laboratory findings, Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scores, isolated microbiological agents, surgical intervention, and mortality rate. Demographic, laboratory, and clinical data were analysed. Among these 45 patients, 14 patients had PG, and 31 patients had NF. The mean age and SD for the NF and PG groups were 50.80 ± 17.67 and 50.78 ± 12.72, respectively. Five patients had rheumatological disorders; four patients had diabetes mellitus (DM) in the PG group. Males had higher risk than females in NF (odds ratio [OR] = 0.077, 95% confidence interval [CI] 0.017-0.34), and females had higher risk in PG (relative risk [RR] = 5). We compared the LRINEC score of NF patients with PG patients. The mean value of this score was 4.53 for PG patients, and 6.06 for NF patients. Fifteen patients (33.3%) had a radiological evaluation. MRI, CT, and USI were used as imaging modalities. Necrotising fasciitis and PG are two distinct entities that are in general difficult to distinguish. Therefore, differential diagnosis and rapid treatment are crucial for lowering the mortality rate.

A rare condition to keep in mind: Pyoderma gangrenosum after breast reduction

Pyoderma gangrenosum is a rare inflammatory disease, characterized by ulcers with purple-colored borders and erythematous halo. Clinically, the patient has fever and severe local pain. Pyoderma gangrenosum can occur after any surgical procedure and the diagnosis is usually delayed. It is important for surgeons and infectologists to be watchful about this rare condition because if misdiagnosed, it has serious results including severely painful ulcerations, prolonged therapy, repeated hospitalizations, psychological trauma, and extensive scarring. The authors report a postsurgical pyoderma gangrenosum case after reduction mammoplasty. This report emphasizes on the importance of awareness about this uncommon disease and its diagnosis.

Post-surgical Pyoderma Gangrenosum: A Retrospective Analysis of four Clinical Cases

Pyoderma gangrenosum is a rare neutrophilic, inflammatory disorder. A recent study from Finland has analysed patient records with postsurgical pyoderma gangrenosum with special focus on the diagnostic delay and treatment outcomes.

Pyoderma Gangrenosum After Abdominal Free Tissue Transfer for Breast Reconstruction: Case Series and Management Guidelines.

Pyoderma gangrenosum following free tissue transfer for breast reconstruction is rare. This unusual ulcerative condition is frequently misdiagnosed, leading to inappropriate debridement and escalation of the subsequent wound through pathergy. Once diagnosed, treatment with immunosuppressive agents, including corticosteroids, results in an initial rapid response, but prolonged treatment is required. There is a paucity of literature regarding how to approach future surgery. This was a retrospective case review from a single center over a 17-year period. All patients diagnosed with postsurgical pyoderma gangrenosum after free tissue transfer from the abdomen for breast reconstruction were included. Of 456 free tissue transfers from the abdomen for breast reconstruction, 8 women who underwent 13 free flaps were diagnosed with postsurgical pyoderma gangrenosum in 10 flaps. The surgeries performed included transverse rectus abdominis muscle (n = 5), deep inferior epigastric perforator (n = 4) and superficial inferior epigastric artery (n = 4) flaps. Mean age at diagnosis was 52.8 years, and 3 patients had preexisting autoimmune conditions: type 2 diabetes mellitus, dermatomyositis, and Graves disease. The mean time of presentation of wound symptoms was 3.9 days after surgery, and mean time diagnosis was made was 9.4 days. Pyoderma gangrenosum after autologous breast reconstruction is a rare, but serious, complication that is worsened by misdiagnosis and inappropriate debridement. We present a case series of 8 patients and emphasize the importance of early recognition and treatment with immune suppression. We include a treatment algorithm to manage these patients, once the diagnosis is suspected. Future surgery can be considered with a fully informed patient and careful collaboration with dermatology colleagues.

Frequently debrided and misdiagnosed: Post-surgical pyoderma gangrenosum

Post-surgical pyoderma gangrenosum is rare. On average it develops 10 days after a surgical procedure. This timeframe is similar to post-operative wound infections, including post-operative necrotizing fasciitis. Consequently, post-surgical pyoderma gangrenosum is frequently misdiagnosed as an infection, leading to detrimental surgical debridement, unnecessary antibiotic use, and delay of proper treatment. We review a case of pyoderma gangrenosum of the right inguinal crease following percutaneous coronary catheterization and review of the literature.

Postoperative Trouble

A 73-year-old man presented 2 weeks after bilateral total knee arthroplasty with painful ulcerative lesions on bilateral surgical sites. The patient first noticed erythema around the incisions 1 week after surgery, which was followed by the development of ulcerations. These lesions progressed despite wound care and a course of oral doxycycline. On examination, both knees had ulcerative lesions with violaceous undermined borders (Figure 1). The radiograph showed well-fixed prosthesis. Synovial fluid analysis showed cell count of 3342 cells/uL with 42% neutrophils and 3035 with 53% neutrophils from the right and left knee, respectively, and cultures remained negative. Skin biopsy was obtained, which showed spongiform pustules and diffuse dermal neutrophilic inflammation consistent with pyoderma gangrenosum (PG). Postoperative pyoderma gangrenosum (PPG) refers to the PG that develops at the surgical site in the immediate postoperative period. In contrast to the PG, which is associated with autoimmune diseases and hematologic malignancies in approximately 50% of the cases, PPG is associated with systemic disease in only 18% to 34% of the cases.1Tolkachjov S.N. Fahy A.S. Cerci F.B. Wetter D.A. Cha S.S. Camilleri M.J. Postoperative pyoderma gangrenosum: a clinical review of published cases.Mayo Clin Proc. 2016; 91: 1267-1279Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 2Zuo K.J. Fung E. Tredget E.E. Lin A.N. A systematic review of post-surgical pyoderma gangrenosum: identification of risk factors and proposed management strategy.J Plast Reconstr Aesthet Surg. 2015; 68: 295-303Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar Symptoms typically appear 7 days after surgery, and most cases are initially misdiagnosed as wound infection, which leads to administration of unnecessary antimicrobial therapy or surgical debridement in 90% and 73% of the cases, respectively.1Tolkachjov S.N. Fahy A.S. Cerci F.B. Wetter D.A. Cha S.S. Camilleri M.J. Postoperative pyoderma gangrenosum: a clinical review of published cases.Mayo Clin Proc. 2016; 91: 1267-1279Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar Diagnosis may be delayed up to 14 days after initiation of symptoms.1Tolkachjov S.N. Fahy A.S. Cerci F.B. Wetter D.A. Cha S.S. Camilleri M.J. Postoperative pyoderma gangrenosum: a clinical review of published cases.Mayo Clin Proc. 2016; 91: 1267-1279Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar Treatment usually includes systemic steroids and/or immunosuppressive medication including tacrolimus or cyclosporine. In our case, the appearance of bilateral painful ulcerative lesions with violaceous undermined margins in the second postoperative week raised the suspicion of PPG. The patient was started on topical tacrolimus and oral prednisone 1 mg/kg daily, which was tapered off over the next 4 weeks with subsequent healing of the lesions (Figure 2).

Postsurgical Pyoderma Gangrenosum Versus Necrotizing Fasciitis: Can We Spot the Difference?

Pyoderma gangrenosum is a rare noninfectious cutaneous disease characterized by expanding areas of skin ulceration around necrotic centers with purulent debris. Exceptionally, it can be precipitated by surgery alone, and this entity has been described as postsurgical pyoderma gangrenosum (PSPG). Cases of PSPG in the literature are rare. We performed a retrospective review of the current literature on PSPG and highlight some observed differences between these conditions. We also present our experience of PSPG imitating an infectious process post reduction mammoplasty. Although PSPG can demonstrate fever, malaise, systemic signs, and serology that mimic the sepsis of necrotizing fasciitis, we identify some features that can aid diagnosis of pyoderma gangrenosum in the absence of pathergy (which is pathognomonic). These include premorbid inflammatory bowel disease, hematological malignancy, or inflammatory polyarthritis; the exquisite and disproportionate pain associated (in particular within surrounding normal skin); symmetrical changes on both breasts; specific histopathological changes with absence of microorganisms; cutaneous wounds demonstrating an ulcerated, violaceous, and undermined edge; and, in this case, bilaterally spared nipple-areola complexes suggesting progression within continuous skin up to but not across incision lines. We hope that, in encouraging a higher index of suspicion, prompt diagnosis, and accurate treatment, a better outcome for both patient and surgeon can be achieved in future cases.

Pyoderma gangrenosum with pathergy: A potentially significant complication following breast reconstruction

The failure of postoperative surgical site infection to resolve after appropriate antibiotic therapy should alert the clinician to other diagnoses. Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that is typically characterized by necrotizing ulceration. PG can be exacerbated by minor trauma leading to exaggerated skin injury, a condition known as pathergy. We present a case series of PG arising after immediate reconstruction for breast oncological surgery from 1st January 2006 to 1st September 2014. 395 immediate breast reconstructions were performed in 335 patients. Three cases of post-surgical PG were identified (0.9%), all in the setting of mastectomy for breast cancer. Two cases underwent immediate reconstruction with pedicled transverse rectus abdominus myocutaneous flaps, and one underwent submuscular expander insertion. A mean delay of 6.3 days was observed from first presentation of symptoms to diagnosis of PG. Immunosuppressants commonly used included methylprednisolone, prednisone, and ciclosporin, with good success at halting disease progress. Significant scarring affected all three women. Once the disease was deemed quiescent, intravenous immunoglobulin used in the perioperative period for further surgical procedures provided favorable results. A diagnostic algorithm is suggested to guide surgeons in investigations and management when post-surgical PG is suspected.

Pyoderma gangrenosum following breast reconstruction: successful treatment with steroids

Introduction: Pyoderma gangrenosum is arare cause of skin necrosis after surgery. It often appears with extensive ulcerations and scaring with significant aesthetic aftermaths. The pathogenesis is poorly understood but often associated with inflammatory diseases, however post-surgical idiopathic pyoderma gangrenosum can occur. Case Report: We report a case of pyoderma gangrenosum following a bilateral breast reconstruction in a 33-year-old woman, successfully treated with steroids. A week after the surgery wounds started to break down and extensive necrotic ulceration appeared quickly covering both breasts. After dermatopathology evaluation she received antibiotics and prednisone and three months later wounds were completely healed and surgery was not necessary.