Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach

Summary:. Tophaceous gout can represent a major problem for hand surgeons when it turns into aggressive nodules, spreading and destroying soft tissue and bone. The combination of ablative and reconstructive surgery may also be complex when the patient refuses amputations and multiple segments are in...

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Autores principales:	Mariarosaria Galeano, MD, PhD, Michele R. Colonna, MD, FEBOPRAS, Sandra Pfanner, MD, Massimo Ceruso, MD
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Surgery RD1-811
Acceso en línea:	https://doaj.org/article/ed3df4b5129a4371a0049ffe35854cbb
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spelling	oai:doaj.org-article:ed3df4b5129a4371a0049ffe35854cbb2021-11-25T07:58:04ZSurgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach2169-757410.1097/GOX.0000000000003912https://doaj.org/article/ed3df4b5129a4371a0049ffe35854cbb2021-11-01T00:00:00Zhttp://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003912https://doaj.org/toc/2169-7574Summary:. Tophaceous gout can represent a major problem for hand surgeons when it turns into aggressive nodules, spreading and destroying soft tissue and bone. The combination of ablative and reconstructive surgery may also be complex when the patient refuses amputations and multiple segments are involved. We present a difficult case, where a customized approach, chosen according to the different features of the osteoarticular and tendon involvement of fingers, adopted different solutions for the four affected rays. A patient suffering from severe gout arthritis with osteoarticular destruction in both hands refused amputations and was treated with several reconstructive procedures. After excision of the tophaceous deposits, a long bone autograft, two segmental cement spacers together with distal arthrodeses, and an osteoarticular allograft were used. Functional pinches were maintained in both hands, even at a 13-year follow up, with the allograft preserved and working. On the other hand, significant osteolysis and bone resorption in all the segments that had undergone stabilization was documented, producing extrusion of both cement and distal interphalangeal joint fusion screws. Pre- and postoperation range of motion, visual analogue scale, disabilities of the arm, shoulder, and hand score, and pinch strength tests showed reduced pain and improved function. A review of literature is presented in particular regarding different reconstructive approaches. Combining different techniques in the same hand can lead to successful osteoarticular reconstruction after tophi resection, above all to avoid amputation. However, long-term follow up shows that functional osteoarticular reconstructions seem to be more stable, whereas osteolysis may damage bone grafts used for arthrodesis and produce screw extrusion.Mariarosaria Galeano, MD, PhDMichele R. Colonna, MD, FEBOPRASSandra Pfanner, MDMassimo Ceruso, MDWolters KluwerarticleSurgeryRD1-811ENPlastic and Reconstructive Surgery, Global Open, Vol 9, Iss 11, p e3912 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811
spellingShingle	Surgery RD1-811 Mariarosaria Galeano, MD, PhD Michele R. Colonna, MD, FEBOPRAS Sandra Pfanner, MD Massimo Ceruso, MD Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach
description	Summary:. Tophaceous gout can represent a major problem for hand surgeons when it turns into aggressive nodules, spreading and destroying soft tissue and bone. The combination of ablative and reconstructive surgery may also be complex when the patient refuses amputations and multiple segments are involved. We present a difficult case, where a customized approach, chosen according to the different features of the osteoarticular and tendon involvement of fingers, adopted different solutions for the four affected rays. A patient suffering from severe gout arthritis with osteoarticular destruction in both hands refused amputations and was treated with several reconstructive procedures. After excision of the tophaceous deposits, a long bone autograft, two segmental cement spacers together with distal arthrodeses, and an osteoarticular allograft were used. Functional pinches were maintained in both hands, even at a 13-year follow up, with the allograft preserved and working. On the other hand, significant osteolysis and bone resorption in all the segments that had undergone stabilization was documented, producing extrusion of both cement and distal interphalangeal joint fusion screws. Pre- and postoperation range of motion, visual analogue scale, disabilities of the arm, shoulder, and hand score, and pinch strength tests showed reduced pain and improved function. A review of literature is presented in particular regarding different reconstructive approaches. Combining different techniques in the same hand can lead to successful osteoarticular reconstruction after tophi resection, above all to avoid amputation. However, long-term follow up shows that functional osteoarticular reconstructions seem to be more stable, whereas osteolysis may damage bone grafts used for arthrodesis and produce screw extrusion.
format	article
author	Mariarosaria Galeano, MD, PhD Michele R. Colonna, MD, FEBOPRAS Sandra Pfanner, MD Massimo Ceruso, MD
author_facet	Mariarosaria Galeano, MD, PhD Michele R. Colonna, MD, FEBOPRAS Sandra Pfanner, MD Massimo Ceruso, MD
author_sort	Mariarosaria Galeano, MD, PhD
title	Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach
title_short	Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach
title_full	Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach
title_fullStr	Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach
title_full_unstemmed	Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach
title_sort	surgical reconstruction of severe tophaceous gout in the hand: a customized approach
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/ed3df4b5129a4371a0049ffe35854cbb
work_keys_str_mv	AT mariarosariagaleanomdphd surgicalreconstructionofseveretophaceousgoutinthehandacustomizedapproach AT michelercolonnamdfebopras surgicalreconstructionofseveretophaceousgoutinthehandacustomizedapproach AT sandrapfannermd surgicalreconstructionofseveretophaceousgoutinthehandacustomizedapproach AT massimocerusomd surgicalreconstructionofseveretophaceousgoutinthehandacustomizedapproach
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Surgical Reconstruction of Severe Tophaceous Gout in the Hand: A Customized Approach

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