J Rheum Dis.  2012 Aug;19(4):230-233. 10.4078/jrd.2012.19.4.230.

Treatment of a Chronic Gouty Ulcer on the Lateral Malleolus with Vacuum-Assisted Closure (VAC) Therapy

• Kim YH
• Kim JS
• Young KW
• Lee HS
• Hur JU
• Lee KT

• KMID: 2223077
• DOI: http://doi.org/10.4078/jrd.2012.19.4.230

Abstract

Gouty ulceration is a clinical manifestation of gout, which is a metabolic disease induced by disturbed purine metabolism. In general, protruded gout tophus and secondary infection made a gouty ulceration. It was generally treated with surgical debridement of the tophus and infected tissue. Inevitably, we make the skin defect if needed the wide surgical debridement. We waited for granulation tissue healing of the defect, then finished with a skin graft. However, larger sized gouty ulcerations require a longer period of healing time. We commonly used the vacuum assisted wound closer device (VAC) for shortening the healing time in diabetic foot ulceration. Use of VAC for a gouty ulceration was not nearly reported in literature. We report on the use of VAC after surgical debridement to heal a chronic gouty ulceration around the lateral malleolus.

Keyword

Gout; Ulceration; Vacuum assisted wound closure

MeSH Terms

Coinfection
Debridement
Diabetic Foot
Gout
Granulation Tissue
Metabolic Diseases
Negative-Pressure Wound Therapy
Purines
Skin
Transplants
Ulcer
Vacuum
Purines

Figure

• 

  Figure 1 A 70-years old male patient came to our hospital with chronic infected ulceration at his lateral malleolar area. The ulceration seen in (A) 5×3 cm defect, pus drainage, whitish materials like tophi. We debrided the wound meticulously, and applied a vacuum assisted wound closure device. The tophus was remained in the soft tissue defect after the debridement (B). (C) shows the well granulated wound after 6 weeks. The wound was healed completely after 10 weeks treatment (D).

Reference

1. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997. 38:563–576.

2. Flack S, Apelqvist J, Keith M, Trueman P, Williams D. An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers. J Wound Care. 2008. 17:71–78.

3. Kemp TJ, Hirose CB, Coughlin MJ, Otto R. Treatment of chronic tophaceous gout with a wound vacuum-assisted device. Foot Ankle Int. 2010. 31:729–731.

4. Kumar S, Gow P. A survey of indications, results and complications of surgery for tophaceous gout. N Z Med J. 2002. 115:U109.

5. Lionelli GT, Lawrence WT. Wound dressings. Surg Clin North Am. 2003. 83:617–638.

6. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997. 38:553–562.

7. Neuberger JS, Neuberger GB. Epidemiology of the rheumatic diseases. Nurs Clin North Am. 1984. 19:713–725.

8. Ou KL, Tzeng YS, Yu CC, Chen TM. Resurfacing tophaceous gout in the foot with anterolateral thigh flap. Microsurgery. 2010. 30:79–82.

9. Yu TF. Pathogenesis and medical management of chronic gouty arthritis. Clin Orthop Relat Res. 1970. 71:40–45.