Postoperatives Pyoderma gangraenosum: eine ernste und seltene Komplikation nach Brustverkleinerung
Küçük Resim Yok
Tarih
2019
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
SpringerLink
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Wir berichten über eine 17-jährige Patientin, die sich Anfang 2019 in unserer stationären Behandlung befand. Die Vorstellung in unserem Haus erfolgte aufgrund sehr starker Schmerzen und nekrotisierender, sich destruktiv ausbreitender Hautulzerationen im Narbenbereich nach Brustverkleinerung. Die Wunde sei im Laufe der Zeit auch um einiges größer geworden, es habe sich ein schmierig-gelblicher Belag gebildet. Nach dem Verbandwechsel mit Aufbringung von Antibiotikumsalbe wurden eine Gewebeprobe und ein Abstrich von der Wunde genommen und eine Blutabnahme durchgeführt. Am zweiten Tag der stationären Aufnahme konnte keine Verbesserung der Beschwerden nachgewiesen werden. Laut der Gewebeprobeuntersuchung und der Blutproben wurden keine Keime festgestellt. Aufgrund des atypischen Charakters der Wunde, bei der sich innerhalb weniger Tage tiefe und sehr schmerzhafte Ulzerationen entwickelten, erbaten wir ein Wundkonsilium. Nach lebhafter Diskussion über den Zustand der Wunde stellte die Hautärztin die Verdachtsdiagnose Pyoderma gangraenosum. Auf Anweisung der Hautärztin wurden zusätzlich kurzfristig oral verabreichte Kortikosteroide (1?mg/kg pro Tag) verordnet. Beim Verbandwechsel kam Tacrolimus zur Anwendung. Die entnommene Gewebeprobe vom Ulkusrand zeigte eine neutrophilenreiche Infiltration der Dermis mit moderaten perivaskulären Lymphozyteninfiltraten. Diese histologischen Befunde entsprachen einer Pyoderma gangraenosum. Die Patientin wurde 10 Tage nach der stationären Aufnahme an ein anderes Universitätsklinikum überwiesen. Dort wurde ebenfalls Pyoderma gangraenosum als Hauptdiagnose festgestellt, und die Kortikosteroid-Tacrolimus-Therapie wurde weiter verabreicht.
This article reports about a 17-year-old female patient who was admitted to this department in early 2019 with painful, necrotizing and destructively spreading skin ulcerations in the scar region after breast reduction. The wound became larger over time with the formation of a yellowish greasy covering. After changing the dressing and application of an antibiotic ointment a tissue sample and a swab from the wound were taken as well as a blood sample. On the second day of hospitalization no improvement in the symptoms could be detected. According to the results of the tissue and blood sample investigations all microbiological tests were negative. Due to the atypical nature of the wound, which developed into deep and very painful ulcerations within a few days, a wound conference was initiated. After a lively discussion on the condition of the wound, the dermatologist proposed the suspected diagnosis of pyoderma gangrenosum. Additionally, the rapid administration of oral corticosteroids (1?mg/kg body weight/day) was prescribed by the dermatologist. Tacrolimus was used instead of antibiotic ointment during the change of dressing. The tissue sample from the margin of the ulcer showed neutrophil-rich infiltration of the dermis with moderate perivascular lymphocyte infiltrates. These histological findings were consistent with pyoderma gangrenosum. The patient was referred to another university hospital 10 days after hospitalization. Pyoderma gangrenosum was also identified there as the main diagnosis and the corticosteroid-tacrolimus treatment was continued.
This article reports about a 17-year-old female patient who was admitted to this department in early 2019 with painful, necrotizing and destructively spreading skin ulcerations in the scar region after breast reduction. The wound became larger over time with the formation of a yellowish greasy covering. After changing the dressing and application of an antibiotic ointment a tissue sample and a swab from the wound were taken as well as a blood sample. On the second day of hospitalization no improvement in the symptoms could be detected. According to the results of the tissue and blood sample investigations all microbiological tests were negative. Due to the atypical nature of the wound, which developed into deep and very painful ulcerations within a few days, a wound conference was initiated. After a lively discussion on the condition of the wound, the dermatologist proposed the suspected diagnosis of pyoderma gangrenosum. Additionally, the rapid administration of oral corticosteroids (1?mg/kg body weight/day) was prescribed by the dermatologist. Tacrolimus was used instead of antibiotic ointment during the change of dressing. The tissue sample from the margin of the ulcer showed neutrophil-rich infiltration of the dermis with moderate perivascular lymphocyte infiltrates. These histological findings were consistent with pyoderma gangrenosum. The patient was referred to another university hospital 10 days after hospitalization. Pyoderma gangrenosum was also identified there as the main diagnosis and the corticosteroid-tacrolimus treatment was continued.
Açıklama
Anahtar Kelimeler
Wundheilung, Wundinfektionen, Postoperative Schmerzen, Kortikosteroid, Tacrolimus, Wound healing, Wound infections, Postoperative pain, Corticosteroids, Tacrolimus
Kaynak
Journal für Ästhetische Chirurgie
WoS Q Değeri
N/A
Scopus Q Değeri
Q4
Cilt
12
Sayı
4
Künye
Şakı, M.C., Güder, H., Karadeniz, A., Güder, S. ve Aköz, T. (2019). Postoperatives Pyoderma gangraenosum: eine ernste und seltene Komplikation nach Brustverkleinerung / Postoperative pyoderma gangrenosum: a serious and rare complication after breast reduction. Journal für Ästhetische Chirurgie, SpringerLink. 12(4), s. 186-190.
