Assessing the role of wound debridement in pyoderma gangrenosum—A retrospective cohort study

The role of wound debridement in pyoderma gangrenosum (PG) is controversial, largely due to concerns regarding pathergy. This study sought to evaluate the clinical outcomes and utility of wound debridement in PG management. We conducted a retrospective cohort study of 104 patients diagnosed with PG at a single tertiary referral centre, stratified into two treatment groups: those receiving debridement in conjunction with immunosuppressive therapy (n = 38) and those treated with immunosuppression alone (control group, n = 66). The primary outcomes measured were remission (absence of active PG lesions without necessitating additional treatment), time to remission and disease progression (new lesions or expansion of existing ones). Remission was achieved by 60.53% (n = 23) in the debridement group versus 87.88% (n = 58) in the control group (p = 0.003). The mean time to remission was 12.3 months for the debridement group versus 8.67 months for the control group (p = 0.2). Multivariate Cox regression analysis indicated that debridement significantly decreased the likelihood of disease remission (adjusted hazards ratio [HR]: 0.45, 95% confidence interval [CI]: 0.26-0.78, p = 0.005). Disease progression was significantly higher in the debridement group (68.42%, n = 26) compared to the control group (15.15%, n = 10) (p < 0.001). Additionally, 28.95% (n = 11) of patients in the debridement group required repeated procedures, and 10.53% (n = 4) underwent amputations due to deteriorating conditions. The timing and duration of immunosuppressive therapy relative to the procedure did not mitigate the risk of post-surgical exacerbations. These findings suggest that debridement is associated with poorer healing outcomes in PG, advocating for its contraindication in the management of this condition.