We present a patient who developed pyoderma gangrenosum (PG) twice, initially after a minor trauma and later after reconstructive surgery. This case is presented to address the frequent misdiagnosis and mistreatment of PG by surgeons. It is of great importance that PG is diagnosed and of even great importance that surgery is avoided in order to prevent pathergy. Our case adds to the understanding that the diagnosis is based on the clinical and histopathological findings and by excluding other causes of skin ulcers. When a wound is not healing despite relevant local wound management and systemic treatment if needed, the clinician should always suspect PG. Early diagnosis and treatment is crucial in the management of PG and surgery is contraindicated.