The Use of Cellular- and/or Tissue-Based Therapy for the Management of Pyoderma Gangrenosum

A Case Series and Review of the Literature

Mabel Ching-Yee Chan, MD; Crystal James, MD; Munir Patel, MD; Scott Ellis, MD; John C. Lantis II, MD

Disclosures

Wounds. 2021;33(6):161-168. 

In This Article

Conclusions

The diagnosis of PG should be considered when a patient presents with or develops painful violaceous skin ulceration that rapidly manifests within days after minor trauma or surgery. With prompt, accurate diagnosis immunosuppressive therapy can be started without delay. Per the literature, the optimal timing of surgical intervention has been variable; some physicians propose completing immunosuppression therapy and operating at the quiescent phase, while others support debridement of necrotic tissue in addition to use of steroids to allow prompt healing and pain control. In cases of wide destruction and extensive wound defects, surgical intervention appears to be necessary to decrease length of hospital stay, decrease pain, and achieve sufficient wound healing. To date, the authors of this case study have found debridement and placement of FBD and CTPs in conjunction with the initiation of immunosuppressive therapy to be effective.

Tissue-based products can be offered as an alternative dressing to provide protection of the wound, decrease long-term immunosuppressive treatment, and potentially reduce the risk of pathergy at the donor site. To the authors' knowledge, this is the first report of using FBD on PG lesions. This case report demonstrates that simultaneous medical therapy and coverage of the wound with FBD coupled with debridement and multilayered compression dressing can be a successful strategy to heal PG lesions. The result after a single application was durable and restored the defect to the level of the surrounding skin, allowing discontinuation of steroid therapy in 20 days. This method of FBD engraftment can also be an effective tool for preparing the wound bed prior to STSG.

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