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2017 ; 17
(ä): e10
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Postsurgical Pyoderma Gangrenosum Following Carpal Tunnel Release: A Rare Disease
Following a Common Surgery
#MMPMID28400897
Objective: Postsurgical pyoderma gangrenosum is a rare but potentially
devastating condition for surgical patients. While pyoderma gangrenosum has 2
subtypes, typical and atypical, each can be further classified by its heralding
features. These include ulcerative, pustular, bullous, and vegetative. The
presentation can be a result of trauma or, as mentioned before, postsurgical. The
plastic and reconstructive surgeon most likely will encounter postsurgical
pyoderma gangrenosum in practice, as it has been reported in patient populations
frequently seen in plastic surgery clinics. Methods: We present a unique case of
idiopathic postsurgical pyoderma gangrenosum in a patient who presented after
carpal tunnel release, the most common surgery of the hand and wrist performed in
the United States annually. This is believed to be the first ever case reported
in the literature of pyoderma gangrenosum following carpal tunnel release.
Results: The patient's disease course was complicated by surgical debridement
prior to diagnosis. Unfortunately, this condition necessitated mid-forearm
amputation. The wound eventually healed with primary closure and appropriate
medical therapy. Conclusion: Previous experience with this disease, a high index
of suspicion, and general education regarding the disease process and its
management could potentially have prevented this outcome. We hope to underscore
that it is important to consider a patient's entire history and to have a high
index of suspicion in unusual postsurgical wounds in order to adequately
diagnose, treat, and manage patients who develop postsurgical pyoderma
gangrenosum.