Perforator propeller flap for coverage of Achilles region defects caused by pyoderma gangrenosum

Chun Wa Fong; Manuel Bento; Feng Jun Fang; Fong Kuong Pang; Io Hang Lio; Sut Sin Tong; Chou Kuan Hao

doi:10.1016/j.jpra.2022.06.008

Perforator propeller flap for coverage of Achilles region defects caused by pyoderma gangrenosum

JPRAS Open. 2022 Jul 6:33:139-144. doi: 10.1016/j.jpra.2022.06.008. eCollection 2022 Sep.

Authors

Chun Wa Fong¹, Manuel Bento¹, Feng Jun Fang¹, Fong Kuong Pang¹, Io Hang Lio¹, Sut Sin Tong¹, Chou Kuan Hao¹

Affiliation

¹ Department of Plastic and Reconstructive Surgery, Centro Hospitalar Conde São Januário, Estrada do Visconde de S. Januário, Macau SAR.

Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease. Systemic corticosteroid and immunosuppressive agents are the mainstay treatment. PG usually precludes a surgical approach due to pathergy phenomenon. Recent literatures show skin grafting and negative pressure wound therapy are safe if performed under adequate immunosuppression. We present a case of a 61-year-old male patient suffered from PG induced left posterior leg wound with Achilles tendon exposure. We made timely diagnosis and treated him with adequate immunosuppression therapy followed by perforator propeller flap for wound coverage. This case report emphasizes the need for high index of suspicion for PG diagnosis. Furthermore, with adequate immunosuppression, operative intervention may not be an absolute contraindication for PG.

Keywords: Propeller flaps; Pyoderma gangrenosum; Surgical treatment.

Publication types

Case Reports