A decade-long case of pyoderma gangrenosum successfully treated with a targeted multimodal protocol: A case report

<h2>Abstract</h2><h3>Introduction</h3> Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic dermatosis that presents significant diagnostic and therapeutic challenges, especially in chronic cases. While medical management is currently the standard, surgical intervention is gaining recognition in select refractory cases. <h3>Body</h3> We present a 39-year-old female with a ten-year history of three chronic, non-healing PG ulcers of the right lower extremity. Prior interventions—including eight debridements, allograft applications, and comprehensive wound care—failed to achieve resolution, each episode complicated by recurrent <i>Staphylococcus aureus</i> and <i>Pseudomonas</i> infections. After initiating the <i>Pyoderma Gangrenosum Precision Care Initiative</i>, a protocol integrating patient education, coordinated multispecialty care, and selective surgical strategies, the patient achieved complete healing. Surgical elements included conservative debridement, split-thickness skin grafting, and negative pressure wound therapy. <h3>Conclusion</h3> This case highlights the efficacy of a structured, multimodal protocol in treating chronic PG and supports an emerging role for surgical intervention as an essential adjunct in select cases.