Deep Ulcer Shaving Combined With Split-Skin Transplantation in Distal Calciphylaxis

Wollina, Uwe; Helm, Catherine; Hansel, Gesina; Koch, Andrè; Schönlebe, Jaqueline; Haroske, G.; Köstler, E

doi:10.1177/1534734608317891

Cited by 21 publications

(12 citation statements)

References 36 publications

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“…With respect to surgical approaches, surgical debridement improved the 1 year survival rate in a retrospective analysis of 63 patients with CUA compared with unmatched controls who did not receive surgical debridement (61.6% survival versus 27.4%), but this result has not been consistent across the literature and likely relies on the surgeon’s expertise with this complex wound type [ 22 ]. A case series of seven CUA patients treated with deep ulcer shaving and split thickness skin graft showed complete healing in six of seven patients and death in only one patient, unrelated to CUA [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Multi-intervention management of calcific uremic arteriolopathy in 24 patients

Harris

Kiaii

Lau

et al. 2018

Clinical Kidney Journal

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BackgroundCalcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare but life-threatening condition predominately occurring in patients with end-stage renal disease on dialysis. In the absence of randomized clinical trials to guide management, clinicians must rely on observational data. We have previously reported the outcomes of our multi-intervention management in seven patients and now present a larger series of patients with extended follow-up.MethodsWe performed a retrospective analysis of all patients diagnosed with CUA at a single academic center between 2008 and 2017. We identified 24 patients including 13 hemodialysis, 8 peritoneal dialysis and 3 predialysis Stage 5 chronic kidney disease patients.ResultsMean age at diagnosis was 60.5 years (range 35–83) and mean follow-up 30.5 months (range <1–99). Patients were predominately female (71%) and Caucasian (83%) with diabetes mellitus diagnosed in 16 of 24 patients. Fifteen of 24 patients had ulcerating lesions suggestive of advanced disease and 20 of 24 had extensive involvement (bilateral disease or lesion size >5 cm). Treatment consisted of intensive hemodialysis (>20 h per week), sodium thiosulfate, wound care, analgesics and discontinuation of trigger medications including warfarin. Hyperbaric oxygen, cinacalcet, bisphosphonates and vitamin K were used in some cases. Overall 1 year mortality was 41% (9/22) and overall mortality at the end of follow-up was 64% (14/24). Cause of death was felt to be attributable to CUA in only four cases (16.7%). Complete or partial resolution of lesions occurred in 17 of 24 patients. One patient had recurrence of CUA 20 months after initial diagnosis.ConclusionsAlthough mortality remains high in this group, direct CUA-attributable mortality is lower than historic reports. We conclude that a multi-intervention approach can be successful in treating a group of patients with severe CUA lesions.

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Section: Discussionmentioning

confidence: 99%

Multi-intervention management of calcific uremic arteriolopathy in 24 patients

Harris

Kiaii

Lau

et al. 2018

Clinical Kidney Journal

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“…12 Deep ulcer shaving combined with split-thickness skin transplantation has been described in the management of distal calciphylaxis. 76 …”

Section: Treatmentmentioning

confidence: 99%

Calciphylaxis: Risk Factors, Diagnosis, and Treatment

Nigwekar

Kroshinsky

Nazarian

et al. 2015

American Journal of Kidney Diseases

365

505

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Calciphylaxis is a rare but devastating condition that has continued to challenge the medical community since its early descriptions in the scientific literature many decades ago. It is predominantly seen in chronic kidney failure patients treated with dialysis (uremic calciphylaxis) but is also described in patients with earlier stages of chronic kidney disease and with normal renal function. In this In Practice feature, we review the available medical literature regarding risk factors, diagnosis, and treatment of both uremic and non-uremic calciphylaxis. High quality evidence for the evaluation and management of calciphylaxis is lacking at this time due to its rare incidence, poorly understood pathogenesis, and the relative paucity of collaborative research efforts. We hereby provide a summary of recommendations developed by the Massachusetts General Hospital's Multi-disciplinary Calciphylaxis Team for calciphylaxis patients.

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“…8 The only other parameter previously shown to favor survival was surgical débridement. 2,18,19 Abbreviations: ASWD, antiseptic wet dressings; BSA, body surface area; CRF, chronic renal failure; DB, débridement; DM, diabetes mellitus; ESRD, end-stage renal disease; F, female; FSGN, focal sclerosing glomerulonephritis; FVL, factor V Leiden heterozygous carrier; GN, glomerulonephritis; HTN, hypertension; IgA, immunoglobulin A nephropathy; KMnO 4 , potassium permanganate; LA, lupus anticoagulant; M, male; Na thios, sodium thiosulfate; O 2 , oxygen; WP, whirlpool. a All patients except for patients 9 and 10 were undergoing dialysis.…”

Section: Commentmentioning

confidence: 99%