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Aydin G, Zaman T. Hyperbaric Oxygen Treatment in the Management of Post-surgical Pyoderma

Gangrenosum Following Reduction Mammoplasty: A Case Report. Undersea Hyperb Med. 2026

Third Quarter; 53(3):505-510.

Introduction: Postoperative pyoderma gangrenosum (PSPG) is a rare but potentially destructive

complication following surgery, often misdiagnosed as infection or necrosis. Mismanagement with

antibiotics or debridement can exacerbate lesions due to the pathergy phenomenon. Hyperbaric

oxygen treatment (HBO2) has been proposed as an adjunctive treatment through its effects on tissue

oxygenation, angiogenesis, and immunomodulation.

Case Report: A 52-year-old woman developed a painful ulcer at the surgical site following bilateral

reduction mammoplasty. Initially treated as a wound infection with antibiotics and repeated

debridements, the lesion rapidly progressed. Histopathology and clinical features supported the

diagnosis of PSPG. Despite systemic corticosteroids, cyclosporine, and infliximab, wound healing

stagnated after three months. The patient was then referred for HBO2(2.4 ATA, 120 minutes, once daily).

After 17 sessions of HBO2 combined with atraumatic wound care, marked improvement was observed

with progressive contraction and granulation. Complete epithelialization was achieved by postoperative

week 38, and no recurrence occurred during six months of follow-up.

Discussion: This case highlights the diagnostic challenges of PSPG and the hazards of inappropriate

interventions. HBO2, when combined with immunosuppressive treatment, may provide an effective

and safe adjunctive option, accelerating wound healing by improving oxygenation and modulating the

inflammatory response. Controlled studies are needed to confirm its role and to establish treatment

protocols in PSPG.

Keywords: breast surgery; inflammation; hyperbaric oxygen; wound healing