A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

Introduction: Pyoderma gangrenosum is a sterile inflammatory neutrophilic dermatosis, of unknown etiology, which is a rare complication (1-2%) of inflammatory bowel diseases (ulcerative colitis and Crohn's disease), characterized by skin ulcers with hemorrhagic or mucopurulent exudate. Incidence is 1 in 330,000 people; occurs between 20 and 50 years, and females are more affected.

EP 556

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

The histology is aspecific: sterile abscesses are observed with dense infiltrate of neutrophils and vascular alterations (veins and capillaries thrombosis, bleeding, necrosis).

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

We report the case of a 52 year old Asian patient suffering from ulcerative colitis who developed multiple skin necrosis from pyoderma gangrenosum with cutaneous eschars localized at the level of the upper limbs, chest, hips, left thigh and foot.

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

Materials and Methods: The patient was treated surgically, with escharectomy and skin grafting at hips, arm and right breast and two operations of bilateral forefoot amputation.

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

Escharectomy performed at the level of the left thigh until reaching a vital plane

Presence of purulent material in the hypodermis

Escharectomy conducted up to the muscular plane

Removal of purulent material

Coverage of the loss of substance with autologous skin grafting

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

After surgery the patient was treated with immunosuppressive therapy (prednisone and cyclosporine, an inhibitor of T lymphocytes) to prevent a recurrence of the underlying disease.

Advanced dressings were applied on all other areas for 50 days * to obtain not only an enzymatic debridement of the eschars, but also to stimulate the healing of the loss of substance.

*Aquacel Ag+ , Convatec.

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

Results: The enzymatic debridement was obtained with an every-two-day application of Bionect Start ™ for 20 days, while the tissue regeneration was achieved using Hyalofill ™ for 30 days until the complete restitutio ad integrum.

A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA GANGRENOSUM IN A PATIENT

S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

EP 556

Conclusions: We believe that after an accurate debridement it is possible to get a complete restitutio ad integrum using advanced dressings to prevent both bacterial infections and to induce tissue regeneration.