The Surgical Management of Chronic Tophaceous Gout

Larmon, William A.; Kurtz, James F.

doi:10.2106/00004623-195840040-00001

Cited by 28 publications

(24 citation statements)

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“…Larmon [2] in 1970 described his technique in detail, including the use of tourniquet, the configuration of incisions, preservation of important structures especially in the hands, the management of open bone defect and the closure techniques. Low recurrence note was noted [10]. Subsequently, the shaving procedure which advocated a more minimally invasive technique has gained popularity [8] [9].…”

Section: Discussionmentioning

confidence: 99%

Revisiting an Old Surgical Approach to the Management of Tophaceous Gout

So¹,

Fok²,

Kwan³

et al. 2017

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The management of gouty tophi has generally shifted from surgical excision to conservative therapy due to surgery's traditional association with high wound complication rate. Yet there are still patients who are indicated for surgical excision of gouty tophi, including for functional or cosmetic reasons. We describe our surgical technique and clinical outcomes in patients who underwent gouty tophi excision. This technique includes near complete excision of non-infected gouty tophi with preservation of important soft tissue structures. We have performed 44 elective tophi excision surgery in ten patients with an average follow-up of 29 months. The overall patients' satisfaction rate was 90%. Only one post-operative infection was noted. No recurrence was observed. Our results suggested that this technique is a safe and effective option for a selected group of patients suffering from tophaceous gout.

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Section: Discussionmentioning

confidence: 99%

Revisiting an Old Surgical Approach to the Management of Tophaceous Gout

So¹,

Fok²,

Kwan³

et al. 2017

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“…The underlying metabolic disorder is hyperuricemia [4]. The most common primary cause is renal under excretion (90%) [5].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 10% of patients with elevated blood levels of uric acid develop gout at some point in their life [5]. In patients in whom the disease has been neglected tophaceous destruction of musculoskeletal structures may be helped by carefully selected surgical procedures [4]. The pathological process involvesdeposition of urates and cause destruction to the skin, ligament, tendon and cartilage [4].…”

Section: Discussionmentioning

confidence: 99%

“…In patients in whom the disease has been neglected tophaceous destruction of musculoskeletal structures may be helped by carefully selected surgical procedures [4]. The pathological process involvesdeposition of urates and cause destruction to the skin, ligament, tendon and cartilage [4]. This process will cause inflammatory response at the site of involvement and cause symptoms to patient.…”

Section: Discussionmentioning

confidence: 99%

“…This process will cause inflammatory response at the site of involvement and cause symptoms to patient. Lesions may be encapsulated in bursae and subcutaneous tissue and infiltrative in skin, tendon, and bone [4].…”

Section: Discussionmentioning

confidence: 99%

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Unusual Locked Trigger Finger Due to Tophaceous Infiltration of Wrist Flexor Tendon

Huang¹

2017

BJSTR

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Changes in Tophus Composition During Urate‐Lowering Therapy: A Dual‐Energy Computed Tomography Study

Chen

Gamble

Horne

et al. 2023

Arthritis Care & Research

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ObjectiveThe gouty tophus is an organized structure composed of monosodium urate (MSU) crystals and chronic inflammatory soft tissue. This dual‐energy computed tomography (DECT) study aimed to determine whether the composition of the tophus changes during urate‐lowering therapy.MethodsSerial DECT scans from 32 people with gout were obtained over 2 years of allopurinol therapy, dose‐escalated to serum urate of <0.36 mmoles/liter. Up to 5 index tophi were selected for each patient, with 103 separate tophi included in the analysis. Using manual outlining methods of conventional CT and DECT scans, the same index tophi were serially measured for total tophus volume and urate volume. For each tophus, the soft tissue volume was then calculated by subtracting the urate volume from the total tophus volume.ResultsThe mean ± SD serum urate reduced from 0.43 ± 0.03 mmoles/liter at baseline to 0.31 ± 0.02 mmoles/liter at year 2. The mean ± SD total tophus volume reduced over the 2‐year period from 5.17 ± 5.55 cm3 to 2.61 ± 2.73 cm3 (P < 0.0001). Greater reductions in tophus urate volumes than tophus soft tissue volumes were observed; the tophus urate volume decreased by 70.6%, and tophus soft tissue volume decreased by 37.8% (P < 0.0001). The mean tophus urate:soft tissue ratio reduced from 0.15 at baseline to 0.05 at year 2 (P < 0.001).ConclusionThe composition of the tophus is dynamic and changes during urate‐lowering therapy for gout management. The soft tissue component of the tophus is slower to respond and may persist without measurable MSU crystal deposition.

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The Surgical Management of Chronic Tophaceous Gout

Cited by 28 publications

References 0 publications

Revisiting an Old Surgical Approach to the Management of Tophaceous Gout

Revisiting an Old Surgical Approach to the Management of Tophaceous Gout

Unusual Locked Trigger Finger Due to Tophaceous Infiltration of Wrist Flexor Tendon

Changes in Tophus Composition During Urate‐Lowering Therapy: A Dual‐Energy Computed Tomography Study

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