HealingWell
Search Close Search
☰

Safe Surgery with Pyoderma Gangrenosum?

Support Forums
>
Crohn's Disease
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted Today 1:24 AM (GMT 0)
I am a wound care doctor who has a patient with Pyoderma Gangrenosum (PG) which is often seen with Crohn's. While on Steroids, he developed cataracts. The PG has nearly cleared up. Since surgery of any kind can potentially lead to a flare up, I need to find a PG patient who has had successful eye surgery for cataracts, to see what treatment they received to prevent the flare up.
Thank you so much.
Posted Today 5:44 AM (GMT 0)
I don't know if this helps you at all, but I've had 2 endoscopic abdominal stricture-type surgeries with PG with the only effect on my PG being one time, which was a small improvement from what I figure was one of the IV antibiotics. Other antibiotics can make it worse, so it was definitely an oddball occurance. I'm going to have my 3rd surery in the next several months, and besides making sure it's super covered up so I don't get staph, I am not even sweating it.I figured with the rarity of PG I might as well pitch in my 2 cents. Thanks for caring so much for your patient!

Post Edited (janicea) : 11/30/2010 10:50:09 PM (GMT-7)

Posted Today 8:15 AM (GMT 0)
I have no personal experience to share.

I do have a suggestion of a professional resource that may be helpful - here's a link to the IBD Working Group website. You will have to register (free) to access the content.

www.ibdwg.org/index.cfm

The website has a case-study article about a patient with UC and Ulcerative PG. Here's a link directly to the article by Dr. Aaron Brzezinski, of the Cleveland Clinic.

thecdwg.org/decisionMaps/brzezinski/index.cfm

If the link doesn't work you can access it from the IBDWG main page by going to Curbside Consults and opening the Archive link to past Decision Maps.

The article doesn't specifically address your question but does discuss treatment of a patient with recurrent PG and differential diagnoses.

Perhaps the references for the article or Dr. Brzezinski may be helpful resources for you.

You don't say that your patient has IBD so please forgive me if this info is not applicable.
Posted 12/3/2010 4:49 AM (GMT 0)
I think all you can do is make sure the underlying disorder if known is under control, maintain the current treatment and reduce exposure to as many antiboitics, unknown meds and pathogens as possible - which should be pretty easy with lens replacement - and just keep on as well as you can. I read pretty much every PG-related article/study/discussion on the web and I've not seen anything that'll give you what you want to know. Unfortunately there is no PG forum on the web that I know of. There almost was here, but it's unfortunately still too orphan.
Posted 12/9/2010 4:24 AM (GMT 0)
http://www.woundsresearch.com/content/immunonutrition-high-risk-surgical-patients
Posted 12/11/2010 3:27 AM (GMT 0)
Male 50 years old 6'2" 230 lbs
PG diagnosed in left lower leg 2000 after ice hockey skate injury. Progressed prior to diagnosis after 9 months and covered 30% of lower calf. Goes into remission but re-flares after trauma to leg from striking objects or rubbing from airline seat.
I developed cataracts from the prednisone (20-80/daily dependent on PG flare) in 2002 after 18 months on prednisone.
I had both lenses blown out and replaced when the PG was in semi remission(less than 20/daily) with no problems healing. Operations were 2 weeks apart.
In 2005 I had to use prednisone eye drops for a corneal disorder, my iris now doesn't appear round, but has an irregular margin.
I finally have tapered off prednisone after 8 years and am injecting Humira 2x monthly. The PG is slowly disappearing from my legs. Am happy to finally be rid of the prednisone and side effects; the Humira has caused very large skin patch flaking and scaling on my legs and I am constantly cold. This is much better than the constant rage and irritability, night sweats, cramps from the prednisone and burning pain from the PG.
Now just working at loosing the weight gain from the prednisone carbo munchies.
Posted 12/28/2010 3:19 PM (GMT 0)
I previously had pyoderma gangrenosum in 2003 and 2004. The first was from a surgical site and took 23 days to be diagnosed. The lesion took six months to heal fully as I had five pounds of skin removed by a surgeon that did not understand the skin disease. The second lesion was diagnosed in 2004 at the same time I was diagnosed with Acute Myelogenous Leukemia. It healed with antibiotic IV and steroids. It really started to improve when they started the first round of induction chemotherapy. I also had a bone marrow transplant at the end of 2004. I am not cancer free and have not had any more episodes of PG. I recently was diagnosed with a hernia in the same area as the first surgical site from 2003. I am facing surgery, but I have no idea whether I am still a patient with PG or not as the bone marrow transplant could possibly have cured that but no one knows. Not the cancer docs or the dermatology docs. I am not sure whether to have the surgery or to prolong it as long as I can.

Any ideas?

Trudy
✚ New Topic ✚ Reply