Management strategies for pyoderma gangrenosum: Case studies and review ofliterature

Pyoderma gangrenosum (PG) is a systemic disease with cutaneous manifestatio ns consisting of necrotizing ulceration. The etiology of PG is controversia l, and optimal management strategies have not been established. Current man agement is primarily medical to control the systemic inflammatory process, with occasional surgical intervention at the ulcer site. Based on the curre nt literature and on the authors' clinical experience, the optimal outcome depends on early diagnoses and a combination of medical and surgical therap y. Initial management is directed toward medical control of the inflammator y process and local wound care. Surgical strategies involve recipient site preparation via local wound care and serial allograft followed by autologou s skin graft or muscle flap coverage when necessary. Long-term wound stabil ization is obtained only through control of the systemic and local inflamma tory process.