ABS ePoster Library

Introduction:
Post surgical pyoderma gangrenosum (PSPG) is rare cutaneous inflammatory skin disorder, which is characterised by painful and necrotic ulceration. We present two patients who developed PSPG following breast reconstructions.

Method:
Patient 1:
39 year old BRCA carrier had bilateral skin sparing mastectomies and immediate implant and dermal sling reconstructions. Five days after surgery she developed worsening wound breakdown and necrosis despite antibiotics and underwent bilateral implant removal and skin debridement. Post op her wound edges continued to deteriorate and a clinical diagnosis of PSPG was made. She was started on steroids and made an uneventful recovery.

Patient 2:
A 65-year-old lady underwent a skin and nipple-sparing mastectomy with an immediate implant and ADM reconstruction. Eight days later, she developed skin blisters and wound breakdown of incision site. She had her implant removed and skin edges debrided. Histology confirmed PSPG. She was started on steroids and made an uneventful recovery.
Discussion:
The diagnosis of PSPG is often made late. Acute onset of nipple sparing skin deterioration and necrosis despite antibiotics should raise the clinical suspicion of PSPG. Histology diagnosis should be attempted however a negative result does not exclude this diagnosis. Steroids and/or immunosuppressants such as cyclosporine or tacrolimus (systemic or topical) have been shown to result in rapid improvement of symptoms.

Conclusion: 
PSPG although rare, causes significant morbidity to patients following breast surgery especially following implant reconstructive surgery. Therefore early diagnosis and treatment is crucial to limit the degree of scarring and reduce the risk of potential implant loss.