Different Surgical Approaches to Treat Chronic Tophaceous Gout in the Hand: Our Experience

Tripoli, Massimiliano; Falcone, Andrea Rainer; Mossuto, Carmela; Moschella, Francesco

doi:10.1097/bth.0b013e3181dcaaa8

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…The main indication for surgery in patients with tophaceous gout is sepsis or infection of ulcerated tophi, followed by mechanical problems, confirmation of diagnosis and pain control [12]. Removal of tophaceous deposits from the hands can be achieved through tenosynovectomy for heavily infiltrated tendons, through a soft-tissue shaving technique for heavy skin infiltration with ulceration and draining fissures [13], or through more complex surgical approaches involving large skin incisions and excision of the tophi [14]. A hydrosurgery system applying a highly pressurized saline stream has also been used with good results for the debridement of tophi [15].…”

Section: Discussionmentioning

confidence: 99%

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

et al. 2011

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IntroductionGout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles.Case presentationWe report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb.ConclusionUlcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.

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Section: Discussionmentioning

confidence: 99%

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

et al. 2011

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“…They closely resemble a nodular lesion arising from a connective tissue disorder such as rheumatoid nodules, and deposits such as skin calcification, chondrocalcinosis, xanthoma, and secondary deposits from kidney and lung cancers, etc. [2,8,9]. Atypical presentation with concomitant giant cell tumor of soft tissue or as a bullous lesion also has been reported [10,11].…”

Section: Results Of Literature Overviewmentioning

confidence: 93%

Management of ulcerated finger pad tophi

Bera¹,

Sharma²,

Gupta³

et al. 2020

Reumatologia

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Finger pad tophi are an unusual but not very rare presentation of uncontrolled gout. Unlike tophaceous lesions of other locations, finger pad tophi are often difficult to diagnose at presentation due to resemblance to a variety of nodular lesions, coexistence with other connective tissue disorders and sometimes occurrence in asymptomatic hyperuricemia. They also pose a therapeutic dilemma due to a lack of clear treatment guidelines. Several case reports of finger pad tophi have been published before, focusing mainly on diagnosis and medical management. We discuss here a case of thumb pad tophi as primary presentation of undiagnosed asymptomatic hyperuricemia and treated surgically with excision and full-thickness skin graft along with urate-lowering therapy. This article highlights the diagnosis and treatment of finger pad tophi. We also discuss the surgical management of tophaceous lesions of hands and digits.

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“…In such cases, surgical management should be discussed to restore and improve the joint function, reduce symptomatic discomfort, and lower the risk of infection when the overlying skin becomes ulcerated. [11][12][13] To avoid compromising neurovascular structures, tendons, and skin, one should not attempt excision of the whole tophus. 14,15 Tophi that are adherent to the skin or tendons are gently curetted or excised sharply.…”

Section: Discussionmentioning

confidence: 99%

Giant Gouty Tophi of the Hand and Wrist

Mittag¹,

Wuenschel²

2011

Orthopedics

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Gout is an inflammatory-rheumatic disease characterized by an elevated serum urate concentration and recurrent flares, including painful, hot, red, and swollen joints and surrounding tissue. Untreated gout often develops into a chronic disease with tophi and destruction of joint surfaces. Giant tophi are often resistant to medication and change in diet.This article presents a case of a 44-year-old man with giant gouty tophi at his hand and wrist. The last acute gout flare in his left wrist was approximately 3 years prior. For 2 years he had refused adequate nutrition, such as a low-purine diet, and had refused to take any preventive medication. Blood urate level was elevated to 8.7 mg/dL (normal range, 3.4-7.0 mg/dL). In time, the tophi led to a massive limitation of motion and use of especially the left wrist and thumb. Under the condition that the patient changed his diet and took the medication for his underlying disease, we surgically removed the almost skin-perforating tophi. Surgical debulking significantly improved joint function and cosmetic appearance.The best treatment for gouty tophi is prevention by ensuring adequate nutrition, treating the underlying causes, and taking effective medication. In the case of massive limitation of joint motion, skin breakdown with risk of infection, and compression of neurovascular structures, surgical debulking of the tophi should be considered.

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Different Surgical Approaches to Treat Chronic Tophaceous Gout in the Hand: Our Experience

Cited by 13 publications

References 12 publications

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

Management of ulcerated finger pad tophi

Giant Gouty Tophi of the Hand and Wrist

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