Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap - a lesson to learn

Pyoderma gangrenosum is a destructive cutaneous disease characterised by pr ogressive painful ulceration. The occurrence of pyoderma gangrenosum at a s urgical site is rare (especially if there is no predisposing illness), but is well recognised. We present a case of a 63-year-old man who developed er ythematous ulcerative lesions due to pyoderma gangrenosum in and around a l ower limb fasciocutaneous flap used to cover an exposed total knee prosthes is. The lesions were initially confused with postoperative wound infection. No predisposing disorder, other than the rarely reported association with osteoarthritis, was found. The diagnosis is important because its rapid det ection not only avoids unnecessary treatment but also allows for prompt int ervention with oral steroids. This case is presented to alert surgeons to t he presence of pyoderma gangrenosum and its diagnostic confusion with posto perative wound infection. (C) 2000 The British Association of Plastic Surge ons.