7 Surgical Management of Tophaceous Gout

Larmon, William A.

doi:10.1097/00003086-197007000-00008

Cited by 27 publications

(17 citation statements)

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“…In this series, the tophaceous masses were cut into small pieces by the rapidly rolling inner cutting blade through the side port of the shaver tip and removed simultaneously by the suction system. Larmon 19 suggests frequent irrigation of the wound during surgery to wash away urate. Because the solubility of urate is markedly temperature-dependent with a twofold increase in solubility between 25°C and 37°C, 7 warm normal saline irrigation is used in this series for lowering the rate of clogging.…”

Section: Discussionmentioning

confidence: 99%

The Soft-Tissue Shaving Procedure for Deformity Management of Chronic Tophaceous Gout

Lee¹,

Lin²,

Lai³

et al. 2003

Annals of Plastic Surgery

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Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. A gouty tophus occasionally mimics an infectious or neoplastic process. However, the conventional enucleating procedure might cause complications. In severe cases, skin necrosis and tendon or joint exposure can occur after debridements. In this series, the soft-tissue shaver is used for deformity management of the chronic tophaceous patients and the results are encouraging. From November 2000 to August 2002, 17 patients with chronic tophaceous gout were treated by the shaver technique. Suction and irrigation were performed simultaneously while the shaver was operating, and chalky deposits of sodium urate could be removed efficiently. Skin necrosis was minimized by means of proper incision planning. Also, bedside debridements and wound wet dressing were helpful for improving the outcomes. The families and patients were satisfied with the results. In conclusion, severe chronic tophaceous gout can be a surgical challenge. The soft-tissue shaving technique can be useful for cosmetic debulking of large tophi in patients with advanced chronic tophaceous gouty arthritis.

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Section: Discussionmentioning

confidence: 99%

The Soft-Tissue Shaving Procedure for Deformity Management of Chronic Tophaceous Gout

Lee¹,

Lin²,

Lai³

et al. 2003

Annals of Plastic Surgery

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“…Approximately 5% of patients may not respond to medical management as a result of which some of these cases may progress to the tophaceous stage. 4 When the skin overlying the tophus deposit becomes ulcerated, microorganisms may enter through the ruptured tophaceous wound, resulting in infection. Large or extensive wounds need joint resection or longterm wet dressing to drain the tophus and to achieve healthy granulation tissue coverage of the wound.…”

Section: Discussionmentioning

confidence: 99%

Free‐flap resurfacing of tissue defects in the foot due to large gouty tophi

et al. 2011

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Chronic tophaceous gout can cause severe skin infection and necrosis, even resulting in deformity or sepsis if left untreated. Surgical debridement is inevitable in patients with extensive wounds. We reconstructed the large, ulcerative skin and soft-tissue defects on the dorsum of the foot by performing free-flap reconstruction after adequate debridement and achieved good functional and cosmetic results.

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“…The initial radiographic lesions, usually asymmetrical, are characterized by thickening of the soft tissues and large erosions, most frequently located in the ulnar dome, carpal bones, and the base of the metacarpals. The articular spaces are usually preserved for a long time, before destruction is caused by crystal deposits in the hyaline cartilage and synovial membrane, which lead to degeneration and ankylosis (Ludwig et al 1938, Hughes et al 1968, Case report of the Massachussetts General Hospital 1970, Larmon 1970, Watt and Middlemiss 1975, Good and Rapp 1978, Bardin and Fritz 1992, Cortet et al 1994, Resnick et al 1995. The initial carpal lesions may correspond to atraumatic aseptic osteonecrosis, initiated by osseous gouty deposits.…”

Section: Discussionmentioning

confidence: 99%