Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature.
Introduction: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by a painful ulceration mimicking infection of the operative site. To this day, there is still no general agreement on the medical and surgical treatment of PG. This systematic review of the literature aims to summari...
| Publicado en: | International Orthopaedics Vol. 42; no. 2; pp. 239 - 246 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Springer Nature
Feb2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127735249&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 127735249 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03412695 NQZ jtl: International Orthopaedics issn: 03412695 maglogo: N pubinfo: dt: Feb2018 vid: 42 iid: 2 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 127735249 127735249 144025598 NLM29119297 127735249 10.1007/s00264-017-3672-2 NLM29119297 127735249 ppf: 239 ppct: 7 formats: tig: atl: Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature. aug: au: Ebrad, Stephan Severyns, Mathieu Benzakour, Ahmed Roze, Benoit Derancourt, Christian Odri, Guillaume-Anthony Rouvillain, Jean-Louis affil: Orthopaedic and Traumatologic Department, Military Hospital Robert Picqué, 351 route de Toulouse, 33140, Villenave d'Ornon, France sug: subj: Pyoderma Gangrenosum Diagnosis Surgical Wound Infection Diagnosis Immunization Methods Human Pyoderma Gangrenosum Etiology Traumatology Statistics and Numerical Data Negative Pressure Wound Therapy Methods Aged, 80 and Over Aged Glucocorticoids Therapeutic Use Adult Postoperative Period Hyperbaric Oxygenation Methods Orthopedics Statistics and Numerical Data Middle Age Pyoderma Gangrenosum Therapy Female Arthritis Impact Measurement Scales Clinical Assessment Tools Questionnaires Scales Aged, 80 & over Aged: 65+ years Adult: 19-44 years Middle Aged: 45-64 years Female ab: Introduction: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by a painful ulceration mimicking infection of the operative site. To this day, there is still no general agreement on the medical and surgical treatment of PG. This systematic review of the literature aims to summarise recent studies about post-operative PG in orthopaedic surgery to improve its medical and surgical management.Method: In April 2017, we carried out an exhaustive review of the literature in MEDLINE, PubMed and Cochrane databases. Key words were pyoderma gangrenosum, orthopaedic surgery, and surgical wound infection. We identified 183 articles. After excluding articles reporting idiopathic PG, cases secondary to non-orthopaedic surgery, and cases about other subtypes of dermatosis, 30 studies were identified. We only included articles reporting PG after orthopaedic or trauma surgery.Results: Thirty-one cases of PG have been reported, 58% (18) of which were in women, whose mean age was 56.5 years. Clinical signs were constant, the most frequently affected site was lower limbs [77.4% (24)] and delay of symptom onset was two to 17 days. Systemic corticosteroid therapy was systematic, polyvalent immunoglobulins were used in two cases and immunosuppressive drugs in one. Negative pressure therapy was used in seven cases and hyperbaric oxygen in three.Discussion: Delayed diagnosis leads to one or more surgical revisions, which could have been avoided by using early and adapted medical treatment. Early onset of a painful and infected ulcer at the operating site in a patient at risk of PG is an indicator that dermatologist advice is recommended before surgical debridement. Surgical revision, outside the inflammatory phase and/or covered by a systemic corticosteroid therapy, does not lead to PG relapse.Level Of Evidence: IV: Systematic revue of the literature. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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