A Mechanically Powered Negative Pressure Device Used in Conjunction with a Bioengineered Cell-based Product for the Treatment of Pyoderma Gangrenosum: A Case Report

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Author(s): 
Katherine Neiderer, DPM, MPH; Billy Martin, DPM, DABPS; Steven Hoffman, DPM; David Jolley, DPM; and James Dancho, DPM, FACFAS

Index: Ostomy Wound Manage. 2012;58(9):44–48.

Abstract

  Pyoderma gangrenosum (PG), an uncommon inflammatory and ulcerative skin disease, typically is treated medically with a combination of immunosuppression and local wound care, but evidence to guide care is limited. PG wounds can be difficult to heal. A 76-year-old male patient presented with a history of rheumatoid arthritis and recalcitrant PG. After 9 months of treatment with local wound care, steroids, and topical tacrolimus, the wound had increased in size from 1.8 cm x 1.5 cm to 7.2 cm x 5.6 cm. At that time, he was started on a regimen of five applications of a bioengineered cell-based product (one application every 2 weeks for a total of five applications) with twice-weekly mechanically powered negative pressure device changes. The latter was started at 75 mm Hg and changed to 125 mm Hg after 4 weeks. Oral corticosteroid therapy was initially started at 40 mg of prednisone, then slowly tapered to 20 mg, but could not be completely discontinued due to a flare in the patient’s rheumatoid symptoms. The wound was completely healed after 16 weeks.



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