ABSTRACT
A 47-year-old man had severe mitral regurgitation after severe skin eruption, so mitral valve replacement was electively performed 8 months later. A median sternal wound opened spontaneously and had purulent exudate on the 5th postoperative day (5 POD). We had suspicion of bacterial mediastinitis, so we drained the anterior mediastinum and tried antibiotic treatment. However, the microbiological stains and culture were negative, and adipose tissue was extremely melted with pustules around the wound. Considering other diseases without infection, we consulted to a dermatologist and tried highdose steroid therapy as pyoderma gangrenosum (PG) appeared on the 8 POD. Meanwhile, the sternum was left open and apllied a negative pressure dressing applied with Negative Pressure Wound Therapy (NPWT). The wound responded remarkably to steroid therapy, so we closed the sternum on the 10 POD, and sutured the sternal wound on the 19 POD. We tapered off steroids after the suture. PG can be caused by the trauma of surgery, so we have to make a decision on whether to use high dose steroid therapy in the postoperative period. We report this case as one of the differential diseases that the surgeons must know.
ABSTRACT
Pyoderma gangrenosum (PG) is an uncommon ulcerating inflammatory neutrophilic dermatosis. Multifactorial pathogenesis has been reported because the underlying mechanism needs to be clearly elucidated. A pathergic reaction is a pathogenic aggravating factor of PG. The occurrence of postoperative PG (PPG) within and involving the borders of a surgical incision site suggests the role of a pathergic reaction in PG. Massive debridement should be avoided in PPG, and it should be immediately managed with oral prednisolone. We present 2 cases of PPG with different clinical courses according to the primary management.