Pyoderma gangrenosum after open heart surgery: A rare and challenging postoperative complication

T. C. Kostopoulos, Alex Ortega Loayza, J. Francis, M. P. Maiberger, N. K. Brinster, D. R. Brinster, M. J. Feldman, J. R. Nunley

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Pyoderma gangrenosum (PG) is an uncommon, necrotizing, neutrophilic dermatosis that can develop after soft tissue injury in susceptible individuals. We describe a rare case of PG that developed within the sternal wound and saphenous vein graft site following open heart surgery for coronary artery bypass grafting and aortic valve replacement. Fever, leukocytosis and sternal wound erythema noted on postoperative day #1 were initially interpreted as signs of a post-operative infection. Aggressive antibiotic management and repeat surgical debridement of the sternal wound had no beneficial effects. Ultimately PG was suspected. Shortly after the initiation of immunosuppressive medications and intravenous immunoglobulin, the wounds stabilized and began to heal. Negative pressure dressings with vacuum-assisted closure systems were used for wound care. After several weeks of immunotherapy, the chest could be closed with a muscle flap and skin grafting. The patient was discharged on immunotherapy which was eventually discontinued after an appropriate taper.

Original languageEnglish (US)
Pages (from-to)37-41
Number of pages5
JournalChirurgia (Turin)
Volume28
Issue number1
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Pyoderma Gangrenosum
Thoracic Surgery
Negative-Pressure Wound Therapy
Wounds and Injuries
Immunotherapy
Soft Tissue Injuries
Skin Transplantation
Intravenous Immunoglobulins
Leukocytosis
Saphenous Vein
Debridement
Erythema
Immunosuppressive Agents
Aortic Valve
Skin Diseases
Coronary Artery Bypass
Fever
Thorax
Anti-Bacterial Agents
Transplants

Keywords

  • Aortic valve
  • Coronary artery bypass
  • Immunoglobulins
  • Immunosuppression
  • Intravenous
  • Wounds and injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Kostopoulos, T. C., Ortega Loayza, A., Francis, J., Maiberger, M. P., Brinster, N. K., Brinster, D. R., ... Nunley, J. R. (2015). Pyoderma gangrenosum after open heart surgery: A rare and challenging postoperative complication. Chirurgia (Turin), 28(1), 37-41.

Pyoderma gangrenosum after open heart surgery : A rare and challenging postoperative complication. / Kostopoulos, T. C.; Ortega Loayza, Alex; Francis, J.; Maiberger, M. P.; Brinster, N. K.; Brinster, D. R.; Feldman, M. J.; Nunley, J. R.

In: Chirurgia (Turin), Vol. 28, No. 1, 01.01.2015, p. 37-41.

Research output: Contribution to journalArticle

Kostopoulos, TC, Ortega Loayza, A, Francis, J, Maiberger, MP, Brinster, NK, Brinster, DR, Feldman, MJ & Nunley, JR 2015, 'Pyoderma gangrenosum after open heart surgery: A rare and challenging postoperative complication', Chirurgia (Turin), vol. 28, no. 1, pp. 37-41.
Kostopoulos TC, Ortega Loayza A, Francis J, Maiberger MP, Brinster NK, Brinster DR et al. Pyoderma gangrenosum after open heart surgery: A rare and challenging postoperative complication. Chirurgia (Turin). 2015 Jan 1;28(1):37-41.
Kostopoulos, T. C. ; Ortega Loayza, Alex ; Francis, J. ; Maiberger, M. P. ; Brinster, N. K. ; Brinster, D. R. ; Feldman, M. J. ; Nunley, J. R. / Pyoderma gangrenosum after open heart surgery : A rare and challenging postoperative complication. In: Chirurgia (Turin). 2015 ; Vol. 28, No. 1. pp. 37-41.
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