Management of a chronic wound secondary to pyoderma gangrenosum following uncomplicated lower segment Caesarean section incision

Pyoderma gangrenosum is a rare postoperative complication. Reports of pyoderma gangrenosum complicating surgical incisions are rare and include plastic surgery of the breast in reduction mammoplasty, cholecystectomy, transabdominal preperitoneal hernioplasty, abdominal stoma surgery/ colectomy in patients with Crohn’s disease, hip joint surgery, orthopaedic surgery involving the extremities, leg amputation and coronary artery bypass grafting. We present our management of a rare case involving pyoderma gangrenosum following lower uterine segment Caesarean section incision, one of only a few other similar cases, and review other reports in the literature. Diagnosis of pyoderma gangrenosum is difficult and may not be recognised immediately. While pyoderma gangrenosum is a rare postoperative complication, initially mimicking infectious causes of wound necrosis, the differential diagnosis of pyoderma gangrenosum versus infection is essential as each condition requires opposing therapeutic regimens. In wounds unresponsive to or worsening despite traditional antimicrobial therapy, it is important that pyoderma gangrenosum be considered as a possible diagnosis. Unlike wound infection, treatment for pyoderma gangrenosum usually consists of immune modulation and the use of corticosteroids. We present an interesting yet challenging case where an initial diagnosis of necrotising fasciitis with subsequent antibiotic therapy failed to produce any clinical improvement. The final diagnosis was pyoderma gangrenosum, and its prudent early consideration in a postoperative wound complication after lower uterine segment Caesarean section (LUSCS) led to a very satisfactory outcome.