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Pyoderma Gangrenosum Following Orthopaedic SurgeryA Case Report and Literature Review
Zhenhua Fang, MD1; Hazibullah Waizy, MD2; Stefan Berger, MD1; Christina Stukenborg-Colsman, MD1; Christian Plaass, MD1
1 Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany E-mail address for C. Plaass: Christian.Plaass@ddh-gruppe.de
2 Clinic for Foot and Ankle Surgery, Hessing Foundation, Hessingstrasse 17, 86199 Augsburg, Germany
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Investigation performed at the Department of Orthopaedics, Hannover Medical School, Hannover, Germany

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Aug 28;3(3):e84 1-6. doi: 10.2106/JBJS.CC.M.00031
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Pyoderma gangrenosum (PG) is a rare immunologic ulcerative skin disease, which can appear spontaneously but is also triggered by trauma. Although PG was first described by Brunstig and O’Leary1 in 1930, the exact pathogenesis of PG has not been clearly determined2,3. PG may occur as a complication following any kind of surgery; it is a rare immunologic and ulcerative disease that mimics an early infection. It mainly has been reported secondary to breast surgery4,5. Few cases of PG associated with orthopaedic surgery or injury have been reported; they include cases related to spine surgery2, arthrodesis of a rheumatoid hand6, hip arthroplasty5,7,8, knee arthroplasty9-12, knee arthroscopy13, tarsal tunnel release6, closed tibial plateau fracture14, and hip fracture15 (Table I). The local appearance of the purulent ulcerated lesion, progressive ulceration, and general symptoms of fever and leukocytosis may mimic a postoperative infection2. Because of the absence of specific laboratory or histopathology tests, PG is always a diagnostic challenge3. A delay in diagnosis may result in surgical debridement, which is a common procedure for postoperative wound infection but is contraindicated for PG before immunomodulation therapy has been initiated2,8. Despite recent advances in treatments, the prognosis of PG remains unpredictable with considerable mortality and morbidity16,17.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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