Pyoderma Gangrenosum after Fat Grafting in Alloplastic Breast Reconstruction: An Unusual Outcome.

Pyoderma gangrenosum (PG) is a rare and painful inflammatory skin disorder that has been recently associated with breast surgery. It is commonly mistaken for postoperative ischemia or wound infection and does not show response to antibiotics or debridement. We describe the first case of post-surgical PG (PSPG) after alloplastic breast reconstruction involving fat grafting. A 47-year-old woman underwent bilateral mastectomy and 2-stage alloplastic breast reconstruction, with fat grafting from the abdomen. Two days post-surgery, she developed bilateral erythema with tender grouped pustules that progressed rapidly into necrotic ulcerations. She did not respond to antibiotics and serial debridement. Subsequent biopsy confirmed a diagnosis of PG. She was started on steroid therapy and responded well. She was discharged on a steroid regimen, local wound care, and eventually a T-cell inhibitor. Over the next 12 months, her wounds healed without surgical intervention. PSPG has been observed in a variety of reconstructive breast surgeries, but never reported in the setting of fat grafting. As PG involves subcutaneous fat, fat grafting may accelerate and exacerbate the course of disease. Treatment for PSPG includes systemic steroid therapy or other immunomodulatory agents (or both). Surgical management remains controversial, as serial debridement and reconstruction have shown to exacerbate and stimulate disease progression. A long-term follow-up is recommended to monitor for wound healing. Delayed diagnosis of PG in breast reconstruction patients can lead to severe morbidity and disfigurement. This is first case of PSPG following fat grafting in the literature

The Teaching Leader Series: Interprofessional Faculty Development Update

Seminar (24 PowerPoint slides) Purpose: The mission of the Teaching Leader Series is to strengthen teaching, learning and assessment skills by providing opportunities and support for faculty to achieve educational excellence, promote interdisciplinary collaboration and encourage instructional innovation. Background: The Series is based on the assumption that an inclusive strategy would help ensure sustainability and that unique learning experiences occur when two or more professions together learned with, from, and about each other’s teaching practice. Since the Series began in 2008 over 20 different topics have been presented including Adult Learning, Curriculum Development, Narrative Medicine, and Teaching with Simulation and Standardized Patients. Description of Intervention or Program: We recognize individuals who have made the Series a part of their educational process and their development as teaching leaders with a pin. In order to receive a pin, participants must attend at least 6 workshops, prepare a report describing how they have applied information from the workshop and must agree to participate in a best practice focus group. Our goal is to have these individuals team teach a workshop with a current presenter who serves as their mentor. Results: The Series demographics are 50% nurses, 25% physicians, and 25% other educators. At the conclusion of each workshop, participants are asked to complete a self-retrospective evaluation. During AY 2011 92% of participants agreed that they would be able to apply what they learned to their job. Pin recipients (physician, pharmacists, nurse) have presented Teaching at the Bedside and Small Group Teaching with a PhD medical educator mentor. Relevance to interprofessional education or practice: Healthcare is practiced in teams and the Series models the importance and effectiveness of interprofessional learning and teaching. Not only are the participants from different disciplines, we also pair presenters from different disciplines. Learning Objectives: Upon completion of this session the participants will be able to Identify the effectiveness of providing interprofessional faculty development. Identify how interprofessional faculty development facilitates collaboration of clinical educators across traditional boundaries. Identify strategies used to integrate interprofessional education into faculty development

Lumbar vertebral osteomyelitis with mycotic abdominal aortic aneurysm caused by highly penicillin-resistant Streptococcus pneumoniae.

We present a case of vertebral osteomyelitis with an adjacent abdominal aortic mycotic aneurysm caused by a highly penicillin-resistant Streptococcus pneumoniae strain. The occurrence of all three phenomena in a single patient has not been previously described. This presentation offers the opportunity to reflect on the increasing incidence of S. pneumoniae as a resistant pathogen, the treatment of highly penicillin-resistant S. pneumoniae, and the etiologic agents of both vertebral osteomyelitis and mycotic aneurysm