Gangrene, postoperative progressiveL88.x

Cullen, 1924

Very rarely occurring after surgery or trauma, large, superficial necrosis of unclear cause, usually localized in the abdominal area.

Mostly after local trauma or post-operative, possibly bacterial mixed infection.

Possible at any age, androtrophy. Mostly in full health.

Preferably abdominal area (e.g. starting from an appendectomy or sectio wound).

1-2 weeks after the operation inflammatory redness, blistery lifting of the epidermis, starting from the wound edges. Formation of an inexorably centrifugally expanding superficial necrosis, possibly eventually encompassing the entire surgical region. Temperature increase, circulatory instability.

Necrotizing fasciitis; Pyoderma gangraenosum.

For superficial weeping skin changes, moist compresses with antiseptic additives such as quinolinol (e.g. quinosol 1:1000) or R042, quinosol baths (1 g/l) or potassium permanganate baths. For deep necroses, wound cleansing, granulation promoting agents and sterile wound dressing. S.u. Wound treatment.

Glucocorticoids p.o. in medium dosage like prednisolone (e.g. Decortin H) 60-100 mg/day, slow reduction over months. Glucocorticoid savings through additional administration of azathioprine (e.g. Imurek) 100 mg/day. Alternatively test with Ciclosporin A (e.g. Sandimmun) 2.5-5 mg/kg bw/day p.o. Cave! Regular, monthly laboratory checks, accompanied by antibiotic protection according to an antibiogram.

Healing with extensive scarring.