Postoperative Pyoderma Gangrenosum After Breast Surgery: A Single-Centre Retrospective Study

Shirley P. Parraga, Jonathan D. Greenzaid, Matthew L. Hrin, Wasim A. Haidari, Kyle E. Robinson, Lindsay C. Strowd
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In this study, we analysed the characteristics of patients who developed PSPG after breast surgery at our academic medical centre.</p><p>Institutional review board was obtained to review the medical records of patients evaluated at Atrium Health Wake Forest Baptist's dermatology clinic between 2010 and 2024 who were diagnosed with PG after breast surgery. A 2:1 randomized control cohort of patients who underwent similar procedures and did not develop PG was utilized for comparison. Parameters analysed included demographics, comorbid conditions, surgical procedures and characteristics, risk factors and postoperative complications. Statistical significance between the PSPG and control cohort was compared.</p><p>The PSPG (<i>n</i> = 11) and control cohort (<i>n</i> = 22) had similar demographic characteristics (Table 1). Associated medical conditions included previous episodes of PG (9% PSPG vs. 0% control, <i>p</i> = 0.33), prior malignancy (55% PSPG vs. 100% control, <i>p</i> = 0.002), and inflammatory arthritis (55% PSPG vs. 18% control, <i>p</i> = 0.05). Patients also had inflammatory skin disorders (36% PSPG vs. 5% control, <i>p</i> = 0.033). Only eczema and psoriasis were identified. No patients in either cohort had a history of leukaemia, lymphoma, or inflammatory bowel disease (Table 1). Patients more frequently developed PSPG following breast reconstruction (55% vs. 5%, <i>p</i> = 0.0025) and reduction (45% vs. 5%, <i>p</i> = 0.0096) compared to the control cohort (Table 1). No differences in suture type were observed between the cohorts (Table 1). The average time between surgery and the onset of PG symptoms was 3.91 months. Seven patients (64%) developed symptoms within 90 days of surgery.</p><p>Classic surgical risk factors were higher for PSPG patients compared to the control cohort (Table 1). Body mass index (BMI) was greater for PSPG patients (33.6 kg/m<sup>2</sup>) compared to the control group (26.6 kg/m<sup>2</sup>, <i>p</i> = 0.0063). The PSPG cohort had more current or former smokers (63% vs. 41%, <i>p</i> = 0.28), diabetics (36% vs. 18%, <i>p</i> = 0.39) and a longer duration of surgical procedure (323 min vs. 226 min, <i>p</i> = 0.21), although these characteristics were not statistically significant. Mean estimated blood loss (EBL) was comparable for both groups.</p><p>Initial versus successful treatments for PSPG patients were also evaluated (Table 2). Most patients were initially treated with systemic antibiotics (73%) and debridement (45%, Table 2) for an average duration of 9.6 months before starting therapy with systemic immunosuppressants. 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引用次数: 0

Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis sometimes induced by trauma, including surgical procedures, through a process known as pathergy [1]. Breast surgery accounts for roughly 25% of postoperative PG (PSPG) cases [1]. Identifying factors associated with developing PSPG is critical for facilitating early recognition and timely intervention [2, 3]. In this study, we analysed the characteristics of patients who developed PSPG after breast surgery at our academic medical centre.

Institutional review board was obtained to review the medical records of patients evaluated at Atrium Health Wake Forest Baptist's dermatology clinic between 2010 and 2024 who were diagnosed with PG after breast surgery. A 2:1 randomized control cohort of patients who underwent similar procedures and did not develop PG was utilized for comparison. Parameters analysed included demographics, comorbid conditions, surgical procedures and characteristics, risk factors and postoperative complications. Statistical significance between the PSPG and control cohort was compared.

The PSPG (n = 11) and control cohort (n = 22) had similar demographic characteristics (Table 1). Associated medical conditions included previous episodes of PG (9% PSPG vs. 0% control, p = 0.33), prior malignancy (55% PSPG vs. 100% control, p = 0.002), and inflammatory arthritis (55% PSPG vs. 18% control, p = 0.05). Patients also had inflammatory skin disorders (36% PSPG vs. 5% control, p = 0.033). Only eczema and psoriasis were identified. No patients in either cohort had a history of leukaemia, lymphoma, or inflammatory bowel disease (Table 1). Patients more frequently developed PSPG following breast reconstruction (55% vs. 5%, p = 0.0025) and reduction (45% vs. 5%, p = 0.0096) compared to the control cohort (Table 1). No differences in suture type were observed between the cohorts (Table 1). The average time between surgery and the onset of PG symptoms was 3.91 months. Seven patients (64%) developed symptoms within 90 days of surgery.

Classic surgical risk factors were higher for PSPG patients compared to the control cohort (Table 1). Body mass index (BMI) was greater for PSPG patients (33.6 kg/m2) compared to the control group (26.6 kg/m2, p = 0.0063). The PSPG cohort had more current or former smokers (63% vs. 41%, p = 0.28), diabetics (36% vs. 18%, p = 0.39) and a longer duration of surgical procedure (323 min vs. 226 min, p = 0.21), although these characteristics were not statistically significant. Mean estimated blood loss (EBL) was comparable for both groups.

Initial versus successful treatments for PSPG patients were also evaluated (Table 2). Most patients were initially treated with systemic antibiotics (73%) and debridement (45%, Table 2) for an average duration of 9.6 months before starting therapy with systemic immunosuppressants. All patients had improvement in PG following the initiation of an average of 39.5 mg daily of prednisone.

PSPG is a rare but serious complication of breast surgery [4]. Pertinent patient features that may be related to the pathogenesis of PG included higher BMI, inflammatory skin conditions and inflammatory arthritis [4, 5]. Most cases of PSPG occurred after breast reconstruction surgeries highlighting the potential role of surgical trauma in triggering pathergy [1, 5]. This study had a small sample size and retrospective design that limit the generalizability of the findings. However, it calls attention to the complexity of PSPG as a rare postoperative complication and identified clinical and surgical factors that predispose patients to this condition. These findings emphasize the need for increased awareness to improve recognition, prevention and management of PG in patients undergoing breast surgery.

Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: Shirley Parraga, Jonathan Greenzaid, Matthew Hrin, Wasim Haidari, Kyle Robinson and Lindsay Strowd. Drafting the article or revising it critically for important intellectual content: Shirley Parraga, Jonathan Greenzaid, Matthew Hrin, Wasim Haidari, Kyle Robinson and Lindsay Strowd. Final approval of the version to be published: Shirley Parraga, Jonathan Greenzaid, Matthew Hrin, Wasim Haidari, Kyle Robinson and Lindsay Strowd. Collection of data: Shirley Parraga, Jonathan Greenzaid and Matthew Hrin. General supervision of the research group: Kyle Robinson and Lindsay Strowd.

Dr. Strowd has received research, speaking and/or consulting support from Pfizer, Novartis, Galderma and Sanofi. The other authors do not have any conflicts of interest to disclose.

The patients in this manuscript have given written informed consent to publication of their case details. Reviewed and approved by Wake Forest University Health Sciences, IRB#00109357.

乳房术后坏疽性脓皮病:一项单中心回顾性研究
坏疽性脓皮病(PG)是一种罕见的中性粒细胞性皮肤病,有时由创伤引起,包括外科手术,通过称为病理[1]的过程。乳房手术约占术后PG (PSPG)病例的25%。识别与PSPG相关的因素对于促进早期识别和及时干预至关重要[2,3]。在这项研究中,我们分析了在我们的学术医疗中心乳房手术后发生PSPG的患者的特征。获得机构审查委员会审查2010年至2024年间在中庭健康维克森林浸信会皮肤科诊所评估的患者的医疗记录,这些患者在乳房手术后被诊断为PG。采用2:1的随机对照队列,接受类似手术但未发生PG的患者进行比较。分析的参数包括人口统计学、合并症、手术程序和特征、危险因素和术后并发症。PSPG组与对照组比较,差异有统计学意义。PSPG组(n = 11)和对照组(n = 22)具有相似的人口统计学特征(表1)。相关医疗条件包括既往PG发作(9% PSPG vs 0%对照,p = 0.33)、既往恶性肿瘤(55% PSPG vs 100%对照,p = 0.002)和炎性关节炎(55% PSPG vs 18%对照,p = 0.05)。患者还患有炎症性皮肤病(36% PSPG vs 5%对照组,p = 0.033)。仅发现湿疹和牛皮癣。两组患者均无白血病、淋巴瘤或炎症性肠病病史(表1)。与对照组相比,乳房重建(55% vs. 5%, p = 0.0025)和乳房缩小(45% vs. 5%, p = 0.0096)后患者更容易出现PSPG(表1)。各组间缝线类型无差异(表1)。从手术到PG症状出现的平均时间为3.91个月。7名患者(64%)在手术后90天内出现症状。与对照组相比,PSPG患者的经典手术危险因素更高(表1)。PSPG患者的身体质量指数(BMI) (33.6 kg/m2)高于对照组(26.6 kg/m2, p = 0.0063)。PSPG组有更多的吸烟者(63%对41%,p = 0.28)、糖尿病患者(36%对18%,p = 0.39)和更长的手术时间(323分钟对226分钟,p = 0.21),尽管这些特征没有统计学意义。两组的平均估计失血量(EBL)具有可比性。还对PSPG患者的初始治疗与成功治疗进行了评估(表2)。大多数患者最初接受全身抗生素(73%)和清创(45%,表2)治疗,平均持续9.6个月,然后开始全身免疫抑制剂治疗。所有患者在开始平均每日39.5 mg强的松治疗后PG均有改善。PSPG是一种罕见但严重的乳房手术并发症。可能与PG发病机制相关的患者特征包括较高的BMI、炎症性皮肤状况和炎症性关节炎[4,5]。大多数PSPG病例发生在乳房重建手术后,这突出了手术创伤在引发病变中的潜在作用[1,5]。本研究样本量小,采用回顾性设计,限制了研究结果的普遍性。然而,作为一种罕见的术后并发症,PSPG的复杂性引起了人们的关注,并确定了使患者易患这种疾病的临床和手术因素。这些发现强调需要提高认识,以提高对乳房手术患者PG的认识、预防和管理。对概念和设计、数据获取或数据分析和解释做出重大贡献:Shirley Parraga、Jonathan Greenzaid、Matthew Hrin、Wasim Haidari、Kyle Robinson和Lindsay Strowd。起草文章或对重要知识内容进行批判性修改:Shirley Parraga, Jonathan Greenzaid, Matthew Hrin, Wasim Haidari, Kyle Robinson和Lindsay Strowd。最终批准出版的版本:雪莉·帕拉格,乔纳森·格林扎德,马修·赫林,瓦西姆·海达里,凯尔·罗宾逊和林赛·斯特罗德。数据收集:Shirley Parraga, Jonathan Greenzaid和Matthew Hrin。研究小组的一般监督:凯尔·罗宾逊和林赛·斯特劳。Strowd获得了辉瑞、诺华、高德美和赛诺菲的研究、演讲和/或咨询支持。其他作者没有任何利益冲突需要披露。本文中的患者已书面知情同意其病例细节的发表。由维克森林大学健康科学审查和批准,IRB#00109357。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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