Hyperbaric Oxygen Treatment in the Management of Post-surgical Pyoderma Gangrenosum Following Reduction Mammoplasty: A Case Report.

Abstract

Introduction: Postoperative pyoderma gangrenosum (PSPG) is a rare but potentially destructive complication following surgery, often misdiagnosed as infection or necrosis. Mismanagement with antibiotics or debridement can exacerbate lesions due to the pathergy phenomenon. Hyperbaric oxygen treatment (HBO₂) has been proposed as an adjunctive treatment through its effects on tissue oxygenation, angiogenesis, and immunomodulation.

Case report: A 52-year-old woman developed a painful ulcer at the surgical site following bilateral reduction mammoplasty. Initially treated as a wound infection with antibiotics and repeated debridements, the lesion rapidly progressed. Histopathology and clinical features supported the diagnosis of PSPG. Despite systemic corticosteroids, cyclosporine, and infliximab, wound healing stagnated after three months. The patient was then referred for HBO₂(2.4 ATA, 120 minutes, once daily). After 17 sessions of HBO₂ combined with atraumatic wound care, marked improvement was observed with progressive contraction and granulation. Complete epithelialization was achieved by postoperative week 38, and no recurrence occurred during six months of follow-up.

Discussion: This case highlights the diagnostic challenges of PSPG and the hazards of inappropriate interventions. HBO₂, when combined with immunosuppressive treatment, may provide an effective and safe adjunctive option, accelerating wound healing by improving oxygenation and modulating the inflammatory response. Controlled studies are needed to confirm its role and to establish treatment protocols in PSPG.