■术后坏疽性脓皮病(PSPG)是一种非常罕见且不可预测的伤口愈合并发症。切口溃疡的快速进展可导致不受约束的裂开。最常见的是,PSPG涉及乳房手术;然而,在这项工作中,我们详细介绍了一例阴茎倒置阴道成形术后10天出现PSPG的患者。
■这种情况下的患者以标准方式进行阴茎内翻阴道成形术和睾丸切除术。她没有PSPG的危险因素。在一次简单的住院后,患者在术后第10天出现疼痛控制困难和浆液性引流增加.在重新接纳时,患者被发现发展得很大,会阴伤口边缘轻度化脓性溃疡。在麻醉下检查,发现新阴道管通畅且完好无损。切口的开裂部分保持开放,并用闭合性铋凡士林敷料修补。皮肤科迅速咨询怀疑PSPG。患者开始使用环孢菌素进行为期18天的泼尼松锥度,还有多西环素和环丙沙星.
■免疫抑制治疗5天后,溃疡明显转化为健康的肉芽组织,不再积极化脓。在另一次冲洗之后,裂开的伤口边缘重新接近。在后续行动中,患者没有PSPG复发的证据,并继续按计划扩张.我们的患者从PSPG中康复,没有进一步的并发症和令人满意的美学效果。
■这个独特的案例突出了及时皮肤科咨询的重要性,免疫抑制,并避免在怀疑PSPG的情况下进一步变热。
UNASSIGNED: Postsurgical pyoderma gangrenosum (PSPG) is a highly uncommon and unpredictable wound healing complication. Rapid progression of ulcers at incisions can cause unfettered dehiscence. Most commonly, PSPG involves breast procedures; however, in this work, we detail a case of a patient who developed PSPG 10 days postoperatively after penile inversion vaginoplasty.
UNASSIGNED: The patient in this case underwent a penile inversion vaginoplasty with orchiectomy in the standard fashion. She had no risk factors for PSPG. Following an uncomplicated hospital stay, the patient developed difficulty with pain control and increasing serous drainage on the 10th postoperative day. On readmission, the patient was found to have developed large, mildly purulent ulcers throughout the perineal wound edges. On exam under anesthesia, the neovaginal canal was found to be patent and intact. The dehisced portions of the incisions were left open and redressed with occlusive bismuth-petrolatum dressing. Dermatology was promptly consulted with suspicion for PSPG. The patient was started on an 18-day prednisone taper with cyclosporine, along with doxycycline and ciprofloxacin.
UNASSIGNED: After 5 days of immunosuppressive treatment, the ulcers visibly converted to healthy granulation tissue and were no longer actively purulent. Following another washout, the dehisced wound edges were reapproximated. At follow-up, the patient had no evidence of PSPG recurrence and continued dilating on schedule. Our patient recovered from PSPG without further complications and a satisfactory aesthetic result.
UNASSIGNED: This unique case highlights the importance of prompt dermatological consultation, immunosuppression, and avoidance of further pathergy in the setting of suspicion for PSPG.