[Pyoderma gangraenosum after implantation of a shoulder endoprothesis]. / Pyoderma gangraenosum nach Implantation einer Schulterendoprothese.

Pyoderma gangrenosum is an inflammatory, ulcerative, neutrophilic dermatosis that is clinically characterized by rapidly evolving, painful, necrotic skin lesions. It is typically associated with chronic systemic inflammatory or neoplastic diseases, but may also occur secondary to cutaneous injury or surgery (pathergy). Post-surgical pyoderma gangrenosum typically develops around surgical sites within the immediate postoperative period, mimicking early wound infection. However, common treatment strategies including antibiotics and debridement fail to improve or even worsen symptoms. Postoperative pyoderma gangrenosum has been most commonly reported from breast and visceral surgery. We present a case of postoperative pyoderma gangrenosum following total shoulder arthroplasty.

The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty.

AIMS: The purpose of the present study was to evaluate the impact of intravenous tranexamic acid on the reduction of blood loss, transfusion rate, and early post-operative clinical outcome in total shoulder arthroplasty. PATIENTS AND METHODS: A randomised, placebo-controlled trial which included 54 patients undergoing unilateral primary stemless anatomical or stemmed reverse total shoulder arthroplasty was undertaken. Patients received either 100 ml saline (placebo, n = 27), or 100 ml saline together with 1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to skin incision and during wound closure. Peri-operative blood loss via an intra-articular drain was recorded and total blood loss was calculated. The post-operative transfusion rate was documented. Assessment of early clinical parameters included the visual analogue scale for pain (VAS), documentation of haematoma formation and adverse events. RESULTS: Mean peri-operative blood drainage (placebo: 170 ml versus TXA: 50 ml, p = 0.001) and calculated mean total blood loss (placebo: 1248.2 ml versus TXA: 871.0 ml, p = 0.009) were significantly lower in the TXA group. No transfusions were necessary during the study period in either group. Mean VAS for pain significantly decreased from pre-operative (VAS 7) to the early post-operative period (VAS 1.7, p < 0.001). Significant differences regarding mean post-operative pain between placebo (VAS 2.0) and TXA (VAS 1.3) were detected (p = 0.05). The occurrence of haematomas was significantly more frequent in the placebo (59.3%, n = 16) than in the TXA group (25.9%, n = 6, p = 0.027). Whereas only mild haematomas developed in the TXA group, in the placebo group a total of 22.2% (n = 6) developed either moderate or severe haematomas. No adverse events associated with administration of TXA occurred. CONCLUSION: Intravenous administration of TXA successfully reduced mean peri-operative blood drainage, total estimated blood loss, pain during the first post-operative days, and haematoma formation in total shoulder arthroplasty. Cite this article: Bone Joint J 2017;99-B:1073-9.