Wanich, Swanson, Wyatt, and Kelly (2012) Describe

Wanich, Swanson, Wyatt, and Kelly (2012) describe the case of a 51-year-old male patient who developed postoperative pyoderma gangrenosum (PG) following a torn right patellar tendon repair.

This particular study as the objective of describing a case of PG through diagnosis and treatment that can be relevant for all medical personnel particularly nurses. PG can be a rare but quite complicated postoperative condition following surgical procedures. It can progress rapidly if not identified and treated properly. The purpose of the article is to describe a case study where the subject developed PG following surgery and to describe the diagnosis and treatment of the condition. Given the goals of Wanich et al. (2012) this method is appropriate to use (case study) and can offer vital information for nurses who treat patients at risk for this condition. In addition, following the case study the authors include a brief discussion of the research related to PG, its clinical features, diagnosis, and treatment. This brief review of the literature on PG is quite helpful in trying in the case study to empirically demonstrated evidence.

Method and Sampling

The case study is an in-depth observation of the development and treatment of PG following a surgical procedure and is an appropriate method to describe the development course of this particular condition. Case studies like this act as didactic tools for nurses and other healthcare workers when they are confronted with a rare and difficult condition to treat. A quantitative study might be appropriate when comparing two different treatment methods over large groups of individuals who contracted the same condition; however, qualitative methods allow for the description of such conditions as well as a guide to treating them. In this particular instance one can see how qualitative and quantitative research complements one another.

A case study is one of the most pure forms of qualitative research. The sample size in this research is a case of one who was recruited for the study via a convenience method (as the patient developed PG following surgery to repair a torn ligament). A case study attempts to cover a specific illness, condition, or situation in depth and typically does so without quantitative measures/descriptors. The subject of this study did give informed consent for his case to be used in this particular research report.

The method used to collect the data for this case study includes radiograph, magnetic resonance imaging (MRI), medical testing, and direct observation. The data focuses on the clinical description of the course of this particular participant's disorder, the clinical observations of the changes in his condition, and the results of medical tests. These procedures are documented in the patient's clinical record as well as in this particular research study. The researchers remain true to the case study method of observation and this particular study is very easy to follow. As this is a case study it can be used to assist nurses and other healthcare professionals in understanding the course and treatment of PG. Because the researchers use the case study and then a brief review of the clinical literature in the diagnosis and treatment of PG is very easy to connect this particular study with other potential cases and treatments of PG. This allows for the case study to be evaluated in terms of the literature on this condition. Thus, the case study method is appropriate for the goals that Wanich et al. (2012) have in presenting this particular case. The findings are presented in the context of understanding the diagnosis in treatment of PG.

Findings

The conclusions of this particular case study a rather general given the authors' goals in simply describing a rare condition following surgery and discussing the treatment that worked in this particular case. The epidemiology, etiology, and pathogenesis of PG are discussed within the context of the literature review and the case. Because the pathogenesis and etiology of PG are not well understood Wanich et al. (2012) make some hypothetical statements regarding the current case and the patient's history and etiology of PG. These hypotheses are totally appropriate in the context of the case in the literature review the follows. Then Wanich et al. (2012) describe all the clinical variations of PG to allow the reader to understand that the particular case in question may not describe the full clinical variations of PG. Thus, the readers are able to understand the experience that the authors have this particular case, relate them to possible cases that they encounter in the future, and use the article is a reference should the readers be confronted with suspected cases of PG.

With respect to the actual findings in the actual case, the patient in question had a medical history that was relatively unremarkable except for suspected Behcet disease (later Wanich et al. discuss that this and similar conditions may represent possible risk factors for PG). The patient reported some light pain after playing golf but had no history of traumatic injury. Outside of some edema in the right tibial tubercle there were no other significant findings. It was thought the patient had a nondisplaced fracture and was put on crutches and weight-bearing restrictions. He was doing well after six weeks however he fell and obtained a torn patellar tendon and underwent surgery to repair this. Ten days following the surgery the wound was noticed to be healing poorly during his first routine follow up. Despite treatment with antibiotics the wound continued to worsen and he was eventually admitted to the hospital for treatment. He was treated with intravenous antibiotics, prednisone, and dapson; however, the wound continued to get worse and eventually histopathological studies indicated spongiosis in the epidermis and massive neutrophils in the deep dermis consistent with PG. The study then describes the ongoing treatment, the patient's response, and adjustments to treatment as the patient's condition is addressed. The case study is accompanied with pictures and clinical data.