Complications Of Pyoderma Gangrenosum Following Facial Surgery

Introduction:

Pyoderma gangrenosum is a rare infectious disease of the skin and face occurring as a complication after any facial surgery. As the condition is rare, the factors causing it are still debatable, and the ideal reasons considered are systemic conditions, hematological disorders, or autoimmune. The infection occurs as a large sore or lesion that is painful. This can be a fast-growing ulcer that can be treated with medication but is most likely to cause a scar. In most post-operative conditions, pyoderma gangrenosum occurs as a challenging scenario to be diagnosed. In many cases, pyoderma gangrenosum is missed out, leading to severe clinical conditions. Pyoderma Gangrenosum is seen in one percent of the cases in around one million population, with a slightly higher incidence in females.

What Is Pyoderma Gangrenosum?

Pyoderma gangrenosum is an ulcerative disease of the skin occurring after a surgical procedure, resulting in a wart or non-healing wound-like appearance. This is a reaction of a compromised immune system, and the exact cause is unknown. The disease is considered a neutrophilic dermatosis (a clinical condition characterized by penetration of neutrophils in the wounded tissues) and is differentiated from pyogenic granuloma.

How Commonly Is Pyoderma Gangrenosum Seen?

As pyoderma gangrenosum is an uncommon condition, the incidence of the disease is seen in only one out of one million patients. However, pyoderma gangrenosum, when seen in patients associated with systemic conditions or other previous dermatological conditions, is said to be a minimum of thirty to fifty percent. Pyoderma gangrenosum is seen affecting both males and females, with slightly higher rates in female patients. All the evidence of pyoderma gangrenosum is seen in all age groups; it predominantly occurs in people in the late fourth and fifth decades of life. The incidence of this condition in children is only around three to four percent.

How Is Pyoderma Gangrenosum after Facial Surgery Clinically Seen?

The clinical symptoms of pyoderma gangrenosum post-surgery are:

• Edema.

• Erythema.

• Inflammation of the operated tissue.

• Rapidly progressing lesion.

• Extreme pain.

The initial lesion appears as a small red papule, which may suddenly progress into a larger ulcerative lesion rapidly. The lesion appears to be extremely painful, commonly seen around sites of recent surgery.

What Are the Complications Of Pyoderma Gangrenosum Following Facial Surgery?

There are a few major complications that are to be considered about pyoderma gangrenosum post facial surgery, and they are:

• Extreme Pain: There are a lot of systemic complications happening in pyoderma gangrenosum that result in extreme pain and are one of the major postoperative concerns.

• Delayed Wound Healing: Healing of the wound is unavoidably delayed in pyoderma Gangrenosum, as the presence of inflammatory cells reacts with the tissue cells preventing the area from healing.

• Scar Formation: As pyoderma gangrenosum is a neutrophilic disease, there is deep penetration and progression of the infection and inflammatory cells within the dermal layers of the skin. This even after debridement may result in a defective scar formation.

• Secondary Infection - As pyoderma gangrenosum is an inflammatory condition, the tissues appear highly edematous (fluid-filled) with active exudates (inflammatory fluids). This condition, where there is an active inflow and outflow of inflammatory fluid, leads to the penetration of microbes resulting in secondary infection.

• Structural Deformity: Pyoderma gangrenosum causes a defect in the altered or rehabilitated structure or even causes a failure in graft rejection or tissue deconstruction. This is because pyoderma gangrenosum causes delayed healing making the tissues weak and more susceptible to secondary infections. In cases of severe infection, the skin tends to lose its form making it more rigid to move or more loose, making it structurally unstable.

• Generalized Fatigue and Flu: Patients with pyoderma gangrenosum experience generalized fatigue, tiredness, and fever as a result of inflammation. Care should be taken to put the patients under antibiotics and keep them hydrated to reduce their temperature. Hydration provides a balance in the system, helping the body to fight against the bacteria.

What Are the Factors Making the Patient More Susceptible To Pyoderma Gangrenosum?

The factors that are to be kept in mind before undergoing facial surgery, as it may process into pyoderma gangrenosum, are:

• Autoimmune conditions like Crohn’s disease, arthritis etc.

• Trauma to the skin.

• Age and sex.

• Blood disorders like acute myelogenous leukemia (a type of cancer involving the production of blood cells).

• Systemic conditions like diabetes etc.

What Is the Prognosis of Pyoderma Gangrenosum?

The prognosis of pyoderma gangrenosum, along with the treatment modalities, is considered to be excellent. However, there is a chance of recurrence of this condition, along with scarring. For a proper and successful prognosis, it is necessary to improve the intake of immunosuppressive therapy along with multiple follow-ups. Also, the occurrence of this disease can be prevented by handling the patient with caution. Minimal invasive techniques are preferred, care should be taken in not causing trauma to the skin, prioritizing sanitation, and proper dressing and wound care are to be considered.

Conclusion:

Pyoderma gangrenosum, although a rare condition, is still known to occur, and it is essential to know all the possible symptoms before performing surgery. A thorough medical and physical checkup should be advised, along with the blood culture reports. Putting the patient on prophylactic antibiotic dosage is also highly advisable as it reduces the chances of infection. Careful monitoring of the patient, post-operatively, with proper hydration through fluids, improvises the healing of the surgical site. Careful and proper wound care and dressing are ideal for the surgical site to heal and combat any secondary infection. So much consideration is put into this condition because facial surgeries are a comprehension of various emotional and mental needs. And in the occurrence of pyoderma gangrenosum, there is a high chance of the surgery not being as successful as expected, which might be depressing the patient. Hence, to prevent all the complications like scarring or surgical drawbacks, all these measures are taken. As pyoderma gangrenosum is one such condition, careful diagnosis, and proper care prevents progression or any further complications.