439 A Rare Cause of Flap Loss and Wound Dehiscence After Immediate DIEP Flap Breast Reconstruction - Raising Awareness of Pyoderma Gangrenosum (Case Report & Literature Review)
M A Sayed, R Wain, S O' Ceallaigh- Surgery
Abstract
Aim
To raise awareness of post-surgical pyoderma gangrenosum (PSPG) as an uncommon but potentially devastating sequelae of free-flap breast reconstruction. Our patient developed PSPG ∼1 week after a DIEP flap. Symptoms and signs were of wound infection, and she was managed as such. Histology and MDT confirmed diagnosis 3 weeks later. Once appropriate treatment was commenced, a good response was seen. However, diagnostic delay meant multiple procedures, antibiotics, and a suboptimal outcome requiring secondary reconstruction.
Method
Retrospective case report compiled using CARE guidance. Literature review using PubMed/Science Direct.
Results
PSPG in free-flap breast reconstruction is rare (∼20 reported cases). Symptoms occur 4 days to 6 weeks post-op. Deteriorating wounds mimicking infection/ischaemia are classical, often associated with ulceration, irregular, raised borders. Positive wound cultures and late evolution of classic signs clouded diagnosis in our case. Our patient had several microbiological, haematological, and radiological investigations in the first 3 weeks; most were equivocal and, in retrospect, likely unhelpful.
Conclusions
PSPG should be considered when post-op wound infection is suspected in cases with non-classical signs. Given its potentially devastating effect on free-flap reconstruction, we recommend PSPG be discussed as a rare but serious complication during consent. A high index of suspicion is needed to avoid unnecessary antimicrobials, detrimental surgical procedures, and initiate appropriate medical management in a timely fashion. Good outcomes can be obtained if recognised early.