Calcified Leg Ulcers in Older Patients: Clinical Description, Morphology, and Chemical Characterization

Abstract

Chronic wounds, including leg ulcers, constitute an important medical problem among older patients. Dystrophic calcifications (DC) are associated with a variety of disorders, including leg ulcers. The aim of this study was to report the clinical and biological characteristics of older patients with DC in leg ulcers and to determine the morphology and chemical composition of these calcifications. We conducted a prospective monocentric study in our Geriatric-Wound and Healing ward, Rothschild Hospital, Paris, from January 2018 to December 2019. Patients with leg ulcers were screened for DC by palpation. Patients’ clinical, biological and radiological findings were collected. DC morphology was analyzed using field-emission scanning electron microscopy and chemical composition was analyzed using µFourier transform infra-red spectroscopy and X-ray Fluorescence. Ten (7%) of the 143 patients hospitalized for leg ulcers presented DC. Older patients with DC were more likely to have leg ulcers with venous insufficiency (P=0.015), colonized by Pseudomonas aeruginosa (P=0.026), with a longer healing evolution (P=0.0072) and hypercalcemia (P=0.041). Five DC were extracted from ulcers: two presented 500 nm lacunar spheres and intermingled fibrils of about 10 nm in diameter, consistent with bacterial and biofilm imprints. DC were always composed of Calcium–phosphate apatite and associated to the presence of Zinc. Our analyses were consistent with the involvement of microorganisms and inflammatory process in DC formation. Early management of venous insufficiency, treatment of chronic bacterial colonization and use of calcium-solubilizing drugs seem to be rational strategies for calcified leg ulcer management in older patients.

Elastic fiber alterations and calcifications in calcific uremic arteriolopathy Running head: Elastin alteration and calcifications in CUA

“…However, although location and ultra-structural aspect of the calci cations were similar in ESRD + CUA and in ESRD, their micrometric organization was different. In ESRD + CUA, multiples spherules regrouped into large calci ed plaques -as previously described in other dystrophic skin calci cations -, while coalescence of calci ed spherules was observed in ESRD patients but did not lead to the formation of such large calci ed plaques 34 . This difference might be explained by a greater quantity of both interstitial and vascular calci cations in ESRD + CUA than in ESRD.…”

Characterization through scanning electron microscopy and μFourier transform infrared spectroscopy of microcalcifications present in fine needle aspiration smears

“…biological calcium phosphate apatite corresponding to two chemical phases namely either carbonated calcium phosphate apatite (CA) or amorphous carbonated calcium phosphate (ACCP) [59][60][61]. We have already found for these two chemical phases such spherical morphology in different parts of the human body, namely kidney [62][63][64][65][66][67][68], breast [69][70][71][72], skin [73,74], cartilage [75,76] or prostate [77]. At this point, it is worth underlining that spherical entities can be made of calcium carbonate [78].…”

Foreword to microcrystalline pathologies: combining clinical activity and fundamental research at the nanoscale

“…We have already investigated biological samples from different organs and parts of the human body, namely kidney [177][178][179][180][181][182][183], prostate [184,185], breast [13,103], thyroid [104][105][106], cartilage [186][187][188][189][190][191][192][193], bone [194][195][196][197], tooth [198], pancreas [199], skin and hairs [53][54][55]147,165,168,[200][201][202][203] and cardiovascular system [140,204,205]. We have also investigated cells [206], mice [207][208][209][210], and medical devices [211,212], as well as chemical compounds identified in k...…”