En Masse Excision and Curettage for Periarticular Gouty Tophi of the Hands.

Eplasty Pub Date : 2022-07-12 eCollection Date: 2022-01-01
Matthew Doscher, Bryan G Beutel, Andrew Lovy, Brandon Alba, Charles Melone
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Abstract

Background: Despite increasing disease prevalence, there remains a paucity of data examining surgical treatments for gouty tophi. This article assesses en masse excision and curettage of articular tophi involving the hands and shows that carefully planned and precisely executed surgery can consistently alleviate pain, preserve function, and enhance the aesthetics of afflicted hands.

Methods: A retrospective review was conducted of all consecutive patients who underwent surgical excision of tophaceous deposits from the upper extremity. All patients had an established diagnosis of gout and had been treated with urate-lowering medication. All tophi were substantive in size and were causing significant digital joint dysfunction and disfigurement with variable skin ulcerations.

Results: The study group included 12 patients with 24 tophaceous deposits excised from the metacarpal and interphalangeal joints; 2 deposits were also concomitantly excised from the wrist and 2 from the elbow. The study group included 8 men and 4 women, with an average age of 67 years. Follow-up evaluation ranged from 2 to 15 years. All patients underwent successful tophus excision with restoration of tendon excursion and joint mobility without wound complications. All regained high levels of function, and all reported satisfaction with their outcome. On follow-up for as long as 15 years, recurrence has not been observed and secondary surgery has not proved necessary.

Conclusions: This study indicates that surgical excision of articular tophi of the hands can provide long-term improvement in function and aesthetics with minimal risk of wound complications or recurrence.

手部关节周围痛风性痛风的整体切除刮除。
背景:尽管疾病患病率不断上升,但关于痛风性痛风的手术治疗的数据仍然缺乏。本文评估了涉及手部关节痛风的大规模切除和刮除,并表明精心计划和精确执行的手术可以持续减轻疼痛,保持功能,并提高患病手的美学。方法:对所有连续接受手术切除上肢白垩沉积物的患者进行回顾性分析。所有患者均有明确的痛风诊断,并已接受降尿酸药物治疗。所有的痛风都是实质性的大小,并引起严重的指关节功能障碍和毁容,并伴有各种皮肤溃疡。结果:研究组包括12例经掌指间关节切除的白垩沉积24例;同时在腕部和肘部分别切除了2例和2例沉积物。该研究组包括8名男性和4名女性,平均年龄为67岁。随访时间为2 ~ 15年。所有患者均成功切除了眼角膜,并恢复了肌腱移位和关节活动,无伤口并发症。所有人都恢复了高水平的功能,所有人都对他们的结果感到满意。在长达15年的随访中,没有观察到复发,也没有必要进行二次手术。结论:本研究表明手术切除手部关节痛风石可以长期改善功能和美观,且伤口并发症或复发的风险最小。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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