After debridement and transitional covering with artificial skin - now vacuum treatment + antibiosis + prednisolone (1 mg/kg body weight/day)The patient suffers from psoriasis, which might be the cause, along with Crohn's disease and other autoimmune diseases.
Treatment is highly complicated. Immunosuppresion is essential, the surgeon should hold off.
Gangrenous pyoderma is a painful skin disease involving extensive ulceration and death of skin, usually just at one site. The disease is not caused by infection (therefore, antibiotics are ineffective), but probably by an overshooting reaction of the immune system (autoimmune disease). Thus it is treated with immunosuppressive drugs, e.g. glucocorticosteroids, salicyl sulfapyridine (Dapson), or cyclosporin A.
Gangrenous pyoderma sometimes occurs as a concomitant disease of e.g. Crohn's disease, ulcerative colitis, rheumatic diseases like rheumatoid arthritis and vasculitis, leukemia and chronic hepatitis.
Treatment: First high doses of cortisone and no or scarce debridement.
This surgery on video