Original Research Article IP Journal of Surgery and Allied Sciences, April-June 2019;1(2):37-39 37 Resurfacing wounds of pyoderma gangrenosum- A surgeon’s nightmare effective interdepartmental communication is the key to success Narendra.S.Mashalkar Associate Professor, Dept. of Plastic Surgery, St. Johns Medical College, Bangalore, Karnataka, India *Corresponding Author: Narendra.S.Mashalkar Email: plasticnaren2005@yahoo.co.in Abstract Introduction: Patients with wounds come in varied forms to a plastic surgeon. Usually chronic wounds which are recalcitrant to conservative treatment require surgical management in the form of resurfacing. All recalcitrant wounds need to be seen with suspicion to identify the underlying systemic disease activity. It is tempting for the plastic surgeon to auto graft each chronic wound as early as possible. This is how a night mare begins. This paper is written with the intention of not hurriedly taking up every chronic wound for resurfacing without properly evaluating the patient and how effective communication with a dermatology colleague will go a long way in benefiting the pt. Aims and objective: 1. To discuss our experience of treating three cases of chronic wounds of P.G and the course and events occurring in each chronic wound till ultimate healing of the wounds. 2. The lessons we learnt during each course. Materials and Methods: A detailed description of course of hospital stay of three cases of P.G with description of interdepartmental discussion and review of literature specifically for surgical management of such wounds. Results: Three cases of chronic wounds of which one had active disease healed with conservative mx and the second case in which the disease became quiescent, a pathergy graft test was done, which eventually had no consequences, later a formal ssg was done with no complications. The third case developed new wounds at surgical sites and conservative management was applied. Conclusion: Lessons learnt; 1. Grafting wounds in cases of chronic wounds with P.G needs to be proceeded with extreme caution. 2. Pathergy test ssg to see for flare ups and to proceed when the disease is quiescent or in inactive phase. 3. Interdepartmental communication is very necessary in such cases. Keywords: Split skin grafting, Pathergy test, Conservative. Introduction Pts with wounds come in varied forms to a plastic surgeon. Usually chronic wounds which are recalcitrant to conservative treatment, require resurfacing. All recalcitrant wounds need to be seen with suspicion to identify the underlying systemic disease activity. It is tempting for the plastic surgeon to auto graft each wound and cover the wound as early as possible. And this is the way a problem may arise on the wound as well as donor site if adequate screening for P.G is not done. This paper is written with the intention of viewing chronic non healing wounds with suspicion, evaluate thoroughly, collaborate with a dermatologist and with the disease in quiescent phase to take up the pt for resurfacing with split thickness auto grafting. This understanding will go a long way in benefiting the pt. Aims and Objective To discuss our experience of treating three cases of chronic wounds of P.G and the course and events occurring in each chronic wound till ultimate healing of the wounds. The lessons we learnt during each course. Materials and Methods A detailed description of course of hospital stay of three cases of P.G with description of interdepartmental discussion and review of literature specifically for surgical management of such wounds. Case 1 A 31-year-old female was referred from a private hospital with a diagnosis of cutaneous Koch’s. She had painful spreading ulcerative lesions in the perineal area. Case 2 A case of P.G with large ulcer on the Antero lateral aspect of the left leg measuring 21 * 26 cms of ulcer since 5 years. Case 3 Pt with P.G were surgery resulted in wounds at various sites. Results and Discussion All the three cases which were seen by us were considered potential candidates for surgery i.e skin grafting. Each case had a different course of stay and events. Elaborating on the same lines. The first case which had chronic non healing wounds of the genital and perineal region had been initially treated as cutaneous Koch’s and had undergone a series of investigations for the same. Upon being referred to us for considering surgical management we had a discussion with dermatology dept, this made us take a safer route with dressings and pathergy testing, also it made us to confirm that the respective pt were in quiescent phase and then perform surgery. As our discussions progressed further a decision was taken to manage the pt conservatively as the pt was in active phase of the disease. All the wounds had healed in a period of 6 months with only dressings. Tay YK et al noted in their