SLR - January 2023 - Solomon Kim, DPM
Title: Clinical Efficacy of Flap Transplantation Combined with Vacuum Sealing Drainage and Methylprednisolone and cyclosporine in the Treatment of Pyoderma GangrenosumReference:Hao Y, He J, Zhao Z, Li C, Feng Z. Clinical efficacy of flap transplantation combined with vacuum sealing drainage and methylprednisolone and cyclosporine in the treatment of pyoderma gangrenosum. Int Wound J. 2022 Nov 2. doi: 10.1111/iwj.14003.
Level of Evidence:III
Reviewed by: Solomon Kim, DPM
Residency Program: Beaumont Farmington Hills Hospital – Farmington Hills, MI
Podiatric Relevance: Pyoderma gangrenosum is a rare skin disease that often causes painful ulcerations to the lower extremities. Although the disease has been associated with neutrophilic inflammatory response and autoimmune involvement, there is no certainty on the pathogenesis and no definite treatment protocol, which can be daunting for the treating physician. The purpose of this study was to evaluate the clinical efficacy of vacuum sealing drainage, and systemic management with hormone and immunosuppressive agents for pyoderma gangrenosum.
Methods: This study retrospectively reviewed 30 patients diagnosed with pyoderma gangrenosum using T-test and chi-square test analysis. 12 patients were in the observation group and 18 patients in the control group. Both groups underwent glucocorticoid (methylprednisolone) and immunosuppressive (cyclosporine) therapy, anti-infection treatment, and maintaining normal blood lab values. In the observation group, non-viable tissue was removed 10 days after glucocorticoid and cyclosporine therapy. Then, they underwent flap transplant with use of wound vac. In the control group, hydrogen peroxide and iodophor were used. Inclusion criteria included 20- to 70-year-old patients with pyoderma gangrenosum, chronic wounds failing >3 months of conservative treatment, and wounds with no exposure to nerves, vessels, tendons, and bones. Exclusion criteria included trauma/burns, wounds on joint area of limbs, contraindications to medications used, diabetes, malignant tumors, and severe malnutrition.
Results: Patients were followed up for 3-12 months, revealing all patients healed with no infection or adverse reaction to medications. Statistical significance is seen with wound healing time, with 35.83 ± 1.95 average days in the observation group and 44.14 ± 9.67 average days in the control group. Another statistical significance was noted with dressing change frequency, 7.17 ± 0.39 average time in the observation group and 79.22 ± 3.62 time in the control group.
Conclusion: Treating pyoderma gangrenosum wounds can be an intimidating endeavor for both the physician and the patient. This article shows that by systemically managing the patient with hormone and immunosuppressants, it allows the patient to be in the optimal position to undergo surgery or other wound care therapies, such as a wound vac. It helps reduce healing time, dressing changes and ultimately improves the quality of life. Despite the small population size, this study shows encouraging results and sets the stage for future exploration of treatment protocols involving pyoderma gangrenosum.