S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo Burns and Plastic Surgery Center (Rome, Italy)

1. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
Introduction: Pyoderma gangrenosum is a sterile inflammatory neutrophilic dermatosis, of
unknown etiology, which is a rare complication (1-2%) of inflammatory bowel diseases (ulcerative
colitis and Crohn's disease), characterized by skin ulcers with hemorrhagic or mucopurulent
exudate.
Incidence is 1 in 330,000 people; occurs between 20 and 50 years, and females are more affected.
EP 556

2. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
The histology is aspecific: sterile abscesses are observed with dense infiltrate of neutrophils and
vascular alterations (veins and capillaries thrombosis, bleeding, necrosis).

3. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
We report the case of a 52 year old Asian patient suffering from ulcerative colitis who developed
multiple skin necrosis from pyoderma gangrenosum with cutaneous eschars localized at the level
of the upper limbs, chest, hips, left thigh and foot.

4. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
Materials and Methods: The patient was treated surgically, with escharectomy and skin grafting
at hips, arm and right breast and two operations of bilateral forefoot amputation.

5. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
Escharectomy performed at the level of the left
thigh until reaching a vital plane
Presence of purulent material in the hypodermis
Escharectomy conducted up to the muscular
plane
Removal of purulent material
Coverage of the loss of substance with autologous
skin grafting

6. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
After surgery the patient was treated with
immunosuppressive therapy (prednisone and cyclosporine,
an inhibitor of T lymphocytes) to prevent a recurrence of the
underlying disease.
Advanced dressings were applied on all other areas for 50
days * to obtain not only an enzymatic debridement of the
eschars, but also to stimulate the healing of the loss of
substance.
*Aquacel Ag+ , Convatec.

7. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
Results: The enzymatic debridement was obtained with an every-two-day application of Bionect
Start ™ for 20 days, while the tissue regeneration was achieved using Hyalofill ™ for 30 days until
the complete restitutio ad integrum.

8. A CASE OF MULTIPLE CUTANEOUS ESCHARS FROM PYODERMA
GANGRENOSUM IN A PATIENT
S Moroni, M Palombo, T Anniboletti, F De Vita, P Palombo
Burns and Plastic Surgery Center (Rome, Italy)
EP 556
Conclusions: We believe that after an accurate debridement it is
possible to get a complete restitutio ad integrum using advanced
dressings to prevent both bacterial infections and to induce tissue
regeneration.