Case report: pyoderma gangrenosum following Deep Inferior Epigastric Perforator (Diep) free flap breast reconstruction.
Pyoderma gangrenosum (PG) is a rare ulcerative dermatologic disease and little is known about its etiology and pathogenesis. Recent reports show that there have been limited but increasing number of cases of PG following aesthetic surgeries. Post-surgical PG is often misdiagnosed, which can have serious clinical consequences. The following case report describes a young woman who underwent a cosmetic breast augmentation and abdominoplasty which was complicated by post-operative necrotizing fasciitis. She was presented one year later for surgical correction of her acquired breast and abdominal deformities. Post-operatively she developed a severe inflammatory skin response presumed to be a wound infection. However, after repeated surgical debridements, the wounds persisted without a defined bacterial or fungal organism. After clinical exclusion of all other etiologies, PG was diagnosed and confirmed with histopathology. The patient was subsequently treated with aggressive immunosuppressive therapy, and the lesions resolved without any signs of residual PG. This case report attempts to increase awareness for the rare post-surgical complication of PG in aesthetic surgery and to improve future diagnosis and management of such cases.