Abstract:
INTRODUCTION: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Li WY,Andersen JC,Jung J,Andersen JSdoi
10.1097/SAP.0000000000001782subject
Has Abstractpub_date
2019-07-01 00:00:00pages
63-68issue
1eissn
0148-7043issn
1536-3708journal_volume
83pub_type
杂志文章abstract::Using a newly developed Doppler probe, we have found that a standard suture anastomosis in a rat femoral artery is accompanied by significant (30-60%) cross-sectional area stenosis, which dissipates to baseline levels within 24 hours. We hypothesized that spasm, deposition of coagulation products, or the suture techni...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199503000-00015
更新日期:1995-03-01 00:00:00
abstract::Breast cancer treatment has dramatically changed over the past century. Since Halsted's first description of radical mastectomy in 1882, breast reconstruction has evolved slowly from being considered as a useless or even dangerous procedure by surgeons to the possibility nowadays of reconstructing almost any kind of d...
journal_title:Annals of plastic surgery
pub_type: 历史文章,杂志文章,评审
doi:10.1097/SAP.0000000000001312
更新日期:2018-04-01 00:00:00
abstract::The authors describe a helical crus reconstruction technique using a postauricular chondrocutaneous flap vascularized by the postauricular vessels. They used this procedure on 7 patients who had developed a large defect on the helical crus following surgery. In each patient the flap design was adjusted to fit the form...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199901000-00011
更新日期:1999-01-01 00:00:00
abstract::Through a transfixion incision, a rhomboidal portion of both the depressor muscle of the nasal septum and the orbicular muscle of the mouth are excised. The remaining columellar tissues are brought nearer to each other by means of a mattress suture tied over a double-foam bolus. This simple procedure yields three adva...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198905000-00001
更新日期:1989-05-01 00:00:00
abstract::Adipose-derived stem cells (ADSCs) are a promising new therapeutic modality for several diseases and have been applied to various clinical fields because of their multidifferentiation potential and capacity for growth-factor secretion. Recently, 2 in vivo studies showed ADSCs to have potential applications in lymphede...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000084
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Soft tissue and bony tumors of the pelvis are rare, but when they occur, treatment presents both an oncologic surgical and a reconstructive challenge. After reconstruction, soft tissue defects can be large and there is usually exposed bone and/or joint. A retroperitoneal abdominal wall defect may also be pre...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000215288.83924.6c
更新日期:2006-08-01 00:00:00
abstract::The experiences of the author while an Officer in the South African Medical Corps are related. During the battle of Britain he was attached to the R.A.M.C. and observed the work of pioneers in modern military plastic surgery. On his return to South Africa, he set up the Brenthurst Military Red Cross Hospital for Plast...
journal_title:Annals of plastic surgery
pub_type: 历史文章,杂志文章
doi:
更新日期:1978-01-01 00:00:00
abstract::Marjolin's ulcer is an uncommon condition in which malignant transformation occurs in a chronic inflammatory focus. It was originally described in association with a thermal injury, however, its occurrence with protean chronic inflammatory foci has been described. We report the occurrence of and aggressive squamous ca...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199512000-00016
更新日期:1995-12-01 00:00:00
abstract::There has recently been an increase in the usage of the Internet as a source of patient information. It is very difficult for laypersons to establish the accuracy and validity of these medical websites. Although many website assessment tools exist, most of these are not practical.A combination of consumer- and clinici...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000216244.81900.3b
更新日期:2006-09-01 00:00:00
abstract::The optic nerve can be injured indirectly by blunt trauma to the frontoorbital region. The mechanism of injury is related to trauma of the nerve in the tight, bony optic canal. Neurovisual transmission in the canal is interrupted by pressure on the nerve. The conventional management includes careful observation and su...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-197811000-00011
更新日期:1978-11-01 00:00:00
abstract::This study was comprised of 9 diabetic patients with 10 infected foot ulcers, including osteomyelitis in 4 limbs and gangrene in 3 limbs. Adequate debridement of these complicated wounds inevitably resulted in exposure of bones or tendons. All defects were successfully reconstructed with free gracilis muscle flaps cov...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199103000-00002
更新日期:1991-03-01 00:00:00
abstract::In this study, brow lifting with botulinum A toxin was performed on patients whose ptosis was corrected using the frontal sling technique, and the effects of this application on ptosis were investigated. Seven patients (with 12 eyelids) on whom the frontal sling procedure was performed using a tensor fascia lata graft...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31823b680a
更新日期:2013-02-01 00:00:00
abstract::Hypertrichosis is an often stigmatizing cosmetic problem not only for women but also for male-to-female transsexual patients. The hitherto described therapeutic measures include chemical epilation, razoring, camouflage, electrolysis and thermolysis, and waxing. All of these measures are transient, more or less painful...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199708000-00009
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:Reduction gonioplasty is very popular in East Asia. However, there has been little quantitative criteria for mandibular angle classification or aesthetics. The aim of this study was to investigate the quantitative differences of mandibular angle types and determine the morphologic features of mandibular angl...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001463
更新日期:2018-07-01 00:00:00
abstract::Skin sparing mastectomy (SSM) removes the breast, nipple-areolar complex, previous biopsy incisions, and skin overlying superficial tumors. Preservation of the native skin envelope facilitates immediate breast reconstruction. The procedure has been adopted for the treatment of breast cancer. All cases of SSM and immed...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200103000-00003
更新日期:2001-03-01 00:00:00
abstract::Ectodermal dysplasia syndrome is a hereditary disease of ectodermal origin. Appearances of nail dystrophy, alopecia or hypotrichosis, saddle nose deformity, and palmoplantar hyperkeratosis are usually associated with a lack of sweat glands as well as partial or complete absence of teeth. These manifestations are usual...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000933
更新日期:2017-06-01 00:00:00
abstract::Experimental end-to-side anastomoses of rabbit arteries less than 1.0 mm in diameter were performed. Technical details, angle of inset, and vessel opening discrepancy are discussed. We emphasize the value of end-to-side arterial anastomoses in increasing the patency rates of anastomoses and consequently the survival r...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198510000-00013
更新日期:1985-10-01 00:00:00
abstract::Pigmented lesions of the nail bed, especially without a history of trauma, represent a diagnostic challenge to the clinician. These lesions are often categorized as melanonychia striata (MS), which refers to any linear tan-brown-black pigmentation of the nail bed. The differential diagnosis of MS includes subungual he...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199608000-00002
更新日期:1996-08-01 00:00:00
abstract::The buccal mucosa has begun to be used as a free graft in complex hypospadias repair gradually and successfully in recent years. However, there are limited experiences regarding use of the buccal mucosa in adult patients. In this study, the authors describe their experience using buccal mucosal grafts in hypospadias-c...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.SAP.0000037274.65665.FF
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Current approaches for the treatment of gingival exposure are often time- and cost-consuming and/or rather invasive. We previously observed a strong correlation between the presence of gingival excess and midfacial depression and here propose an easy 1-step correction technique as a new strategy to improve g...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000735
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Despite a plethora of monitoring techniques reported in the literature, only a small number of studies directly address clinical relevant end points, such as the flap salvage rate and false-positive rate. METHOD:We conducted a systematic review of current evidence regarding the postoperative monitoring of m...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e3181f8cb32
更新日期:2015-05-01 00:00:00
abstract::Craniofacial surgical techniques have yielded better methods of treating severe craniofacial trauma. In this paper surgical techniques are discussed in principle and specifically presented through case reports. We conclude that the most important factors for successful reconstruction after craniofacial trauma are to d...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198612000-00012
更新日期:1986-12-01 00:00:00
abstract:UNLABELLED:When immediate reconstruction is applied to breast conservation therapy (BCT), the benefits extend well beyond the minimization of poor cosmetic results. The purpose of this analysis was to compare literature outcomes between BCT alone and BCT with the oncoplastic approach. METHODS:A meta-analysis was perfo...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,meta分析
doi:10.1097/SAP.0b013e3182605598
更新日期:2014-02-01 00:00:00
abstract::There are a variety of traditional treatments for the removal of unwanted hair. Recently, lasers have been developed to remove hair. The long-pulsed ruby laser uses light at a wavelength of 694 nm with a 3-msec pulse to destroy hair. Seventy-two patients were treated with this laser from one to four times in a variety...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199807000-00001
更新日期:1998-07-01 00:00:00
abstract::Recurrent soft-tissue digital masses with osseous components frequently result in diagnostic and treatment dilemmas. We discuss a case of a recurrent fibro-osseous pseudotumor of the digit, review specific diagnostic and histological features, and recommend treatment. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199603000-00017
更新日期:1996-03-01 00:00:00
abstract::Sagging of the remaining breast behind the inframammary fold after breast reduction or breast augmentation may necessitate revisional surgery. The authors achieved inframammary fold reconstruction by reconstruction of the inframammary crease ligament through a deepithelialized skin flap that is anchored to the periost...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.SAP.0000037279.69711.53
更新日期:2003-04-01 00:00:00
abstract:ABSTRACT:Subungual exostosis is a benign tumor that occurs under the nail plate of the distal phalanx and causes nail deformity and pain. There are many reports of recurrence and postoperative nail deformity, and the surgical approach needs to be reassessed. Two typical surgical approaches are from the nail fold and th...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002619
更新日期:2020-12-15 00:00:00
abstract::We developed a new operative procedure involving the combination of 5 flaps to treat little toe polysyndactyly. We applied this procedure to 4 toes of 3 patients who had severe polysyndactyly involving skin fusion of the area from the distal interphalangeal joint to the periphery. In all 3 patients, this procedure all...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181cbfcf2
更新日期:2011-08-01 00:00:00
abstract::A short operative time and a high successful rate of microvascular anastomosis are the goals of many plastic surgeons. The authors present their experimental and clinical experience in microvascular anastomoses with the use of a combination of continuous suture and interrupted tie. Twenty rats were divided into two gr...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200045030-00010
更新日期:2000-09-01 00:00:00
abstract::Circumcision is a commonly performed minor surgical procedure; however, it may lead to serious complications if performed by poorly trained health care providers. In this case report, a subglanular stricture causing a mushroom-like deformity resulting from circumcision is presented. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.SAP.0000024754.83430.05
更新日期:2003-02-01 00:00:00