Analysis of surgical treatment in parotid gland carcinoma (original) (raw)
2009, JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY
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Pyoderma gangrenosum arising after the surgery for lower gingival cancer
Journal of Japanese Society of Oral Oncology, 2018
Pyoderma gangrenosum (PG) is an uncommon rapid progressive and ulcerating skin disease of unknown etiology. The early lesion shows a clinical feature similar to postoperative infection, so the diagnosis of PG is difficult. In this report, we present a rare case of PG arising after surgery for oral cancer. A 72-year-old woman received radical resection for lower gingival cancer with reconstruction using delto-pectoral flap (D-P flap). Six days after the surgery, she had pyrexia and water diarrhea. The submandibular skin around the insertion site of the D-P flap became reddish with diffuse swelling, pus discharge and severe tenderness. A provisional diagnosis was postoperative infection of the wound. Although the patient was given repeated courses of antibiotics, debridement and drainage, the lesion extended to the whole neck of the affected side and a necrotic ulcer with bluishpurple undermined borders surrounded by erythema was observed 13 days after the surgery. The patient was referred to a dermatologist and PG was strongly suspected. From the postoperative 15 th day, treatment with prednisolone and minocycline over the next several days improved her symptoms dramatically. Histopathological examination revealed that severe inflammatory cells, predominantly of neutrophils, had infiltrated into the dermis without bacterial components. These clinical and histopathological findings fulfilled the diagnostic criteria of PG. PG should be taken into consideration as a potential complication in oral and maxillofacial surgery too.
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