A 75 year old male patient with known past medical history diabetes and
hypertension presented to the emergency room with retrosternal chest
pain and was diagnosed with NSTEMI. His cardiac catheterization
confirmed 2 Vessel coronary artery disease. He was accepted for open
Heart surgery and underwent CABG-2 with no intraoperative complications.
On the 4th postoperative day, the patient spiked fever 38.5c therefore,
full septic work-up was performed. It was noted that the patient had
inflammation around his sternotomy incision, consistent with cellulitis.
He was then started on broad spectrum antibiotics. Next day he had
superficial skin necrosis picture(Figure1A), patient Had aggressive
debridement in the anterior chest wall and the sternal wires were
removed(Figure 1B). Skin biopsy was taken during the procedure and came
back positive for Pyoderma Gangrenousum(PG). Steroids were initiated and
2 weeks later the patient went for sternal plating and bilateral
pectoralis muscle flaps and VAC dressing (Figure 1C).
Patient was discharged home 3 months after the initial surgery with 3
times weekly VAC dressing change. We had close follow up with him and
can confirm that complete healing was achieved 2 months after discharge
from Hospital (Figure1D).
We would like to show an image of a rare case of PG post coronary artery
bypass surgery.
PG is very rare, inflammatory skin disease that rarely complicates
postoperative course after open heart surgery1.
PG could mimic early postoperative sternal wound infection. Steroids
therapy is the only method of treatment recognizing the fact that
steroids can lead to immunosuppression and inhibits healing after major
surgery.
Reference:
1- Richard P. Rand, John E. Olerud, and Edward D. Verier, Pyoderma
Gangrenosum After Coronary Artery Bypass Grafting Ann Thorac Surg
1993; 55 : 1016.
Figure 1A-picture of sternal wound infection.
1B-Post anterior chest wall debridement.
1C-post sternal plating and muscle flap.
1-D complete healing.