Split skin grafts in the treatment of pyoderma gangrenosum - A report of four cases

BACKGROUND. Pyoderma gangrenosum (PG) is an uncommon necrotising, non-infec tive ulceration of the skin. The management of PG is aimed at limiting tiss ue destruction, promoting the healing of the wound, and providing an accept able cosmetic result. However, skin grafting is normally avoided because of the potential risk of pathergy-the localization of skin damaged by trauma. REPORT. We describe the use of split skin grafts in the management of ulcer ative pyoderma gangrenosum in 4 patients. RESULTS. Our cases demonstrate that split skin grafts are a useful treatmen t modality in patients with ulcerative PG, producing a good cosmetic result . One case illustrates the importance of ensuring the disease is quiescent prior to grafting, to avoid pathergy. The other cases emphasise the need fo r prolonged immunosuppressive therapy to minimise the chance of reactivatio n of the disease process. CONCLUSION. Our preliminary experience of 4 cases of ulcerative PG indicate s that split skin grafts have a role to play in its management. The ultimat e cosmetic result is considered to be superior to allowing the wound to hea l by secondary intention. To limit the risk of pathergy developing, our exp erience suggests a role for prolonged courses of immunosuppressive therapy. The most effective dose and duration of immunosuppressive therapy in patie nts with PG treated with split skin grafts remains to be determined. A cont rolled study would be of benefit to compare it with other current treatment options.