Free-flap resurfacing of tissue defects in the foot due to large gouty tophi

Chin-Ta Lin, Shun-Cheng Chang, Tim-Mo Chen, Niann-Tzyy Dai, Ju-Peng Fu, Shou-Cheng Deng, Yuan-Sheng Tzeng, Shyi-Gen Chen

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of complex soft-tissue defects of the foot is still challenging. The purpose of this report was to review the outcomes of free-flap reconstructive surgery for treating the metatarsal joint defects of the feet caused by chronic tophaceous gout. Methods: Ten patients who had large tophus masses (>5 cm) and ulceration on the feet were admitted to our hospital between September 2006 and September 2010. Six patients underwent free-flap reconstruction after debridement to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for exposed tendons. The patients' age, sex, comorbidities, location and size of the defects, reconstructive procedures, surgical outcomes, complications, follow-ups, and recurrence of tophaceous gout were reviewed and recorded. Results: The mean patient age was 49.8 years (range, 36-72 years). The average skin defect size was 92.2 cm 2. Five patients were treated using free anterolateral thigh flaps, and 1, using a free medial sural flap. These free flaps were safely raised and showed excellent functional and cosmetic results, with a mean follow-up of 31.7 months (range, 7-50 months). Conclusion: Chronic tophaceous gout can cause severe skin infection and necrosis, even resulting in deformity or sepsis if left untreated. Surgical debridement is inevitable in patients with extensive wounds. We reconstructed the large, ulcerative skin and soft-tissue defects on the dorsum of the foot by performing free-flap reconstruction after adequate debridement and achieved good functional and cosmetic results. © C 2011 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)610-615
Number of pages6
JournalMicrosurgery
Volume31
Issue number8
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Free Tissue Flaps
Foot
Gout
Reconstructive Surgical Procedures
Debridement
Cosmetics
Tendons
Skin
Necrosis
Foot Joints
Metatarsal Bones
Wounds and Injuries
Thigh
Comorbidity
Drainage
Sepsis
Joints
Bone and Bones
Recurrence
Infection

Keywords

  • adult
  • age
  • aged
  • anterolateral thigh flap
  • article
  • clinical article
  • comorbidity
  • debridement
  • feet tophaceous gout
  • female
  • free tissue graft
  • gout
  • human
  • leg ulcer
  • male
  • medial sural flap
  • patient safety
  • priority journal
  • sex difference
  • skin necrosis
  • skin ulcer
  • surgical wound
  • tarsometatarsal joint
  • tendon
  • treatment outcome
  • Adult
  • Aged
  • Arthritis, Gouty
  • Follow-Up Studies
  • Foot Ulcer
  • Gout
  • Graft Survival
  • Humans
  • Male
  • Microsurgery
  • Middle Aged
  • Retrospective Studies
  • Sampling Studies
  • Severity of Illness Index
  • Skin Transplantation
  • Surgical Flaps
  • Taiwan
  • Toes
  • Treatment Outcome
  • Wound Healing

Cite this

Lin, C-T., Chang, S-C., Chen, T-M., Dai, N-T., Fu, J-P., Deng, S-C., ... Chen, S-G. (2011). Free-flap resurfacing of tissue defects in the foot due to large gouty tophi. Microsurgery, 31(8), 610-615. https://doi.org/10.1002/micr.20949

Free-flap resurfacing of tissue defects in the foot due to large gouty tophi. / Lin, Chin-Ta; Chang, Shun-Cheng; Chen, Tim-Mo; Dai, Niann-Tzyy; Fu, Ju-Peng; Deng, Shou-Cheng; Tzeng, Yuan-Sheng; Chen, Shyi-Gen.

In: Microsurgery, Vol. 31, No. 8, 2011, p. 610-615.

Research output: Contribution to journalArticle

Lin, C-T, Chang, S-C, Chen, T-M, Dai, N-T, Fu, J-P, Deng, S-C, Tzeng, Y-S & Chen, S-G 2011, 'Free-flap resurfacing of tissue defects in the foot due to large gouty tophi', Microsurgery, vol. 31, no. 8, pp. 610-615. https://doi.org/10.1002/micr.20949
Lin, Chin-Ta ; Chang, Shun-Cheng ; Chen, Tim-Mo ; Dai, Niann-Tzyy ; Fu, Ju-Peng ; Deng, Shou-Cheng ; Tzeng, Yuan-Sheng ; Chen, Shyi-Gen. / Free-flap resurfacing of tissue defects in the foot due to large gouty tophi. In: Microsurgery. 2011 ; Vol. 31, No. 8. pp. 610-615.
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abstract = "Background: Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of complex soft-tissue defects of the foot is still challenging. The purpose of this report was to review the outcomes of free-flap reconstructive surgery for treating the metatarsal joint defects of the feet caused by chronic tophaceous gout. Methods: Ten patients who had large tophus masses (>5 cm) and ulceration on the feet were admitted to our hospital between September 2006 and September 2010. Six patients underwent free-flap reconstruction after debridement to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for exposed tendons. The patients' age, sex, comorbidities, location and size of the defects, reconstructive procedures, surgical outcomes, complications, follow-ups, and recurrence of tophaceous gout were reviewed and recorded. Results: The mean patient age was 49.8 years (range, 36-72 years). The average skin defect size was 92.2 cm 2. Five patients were treated using free anterolateral thigh flaps, and 1, using a free medial sural flap. These free flaps were safely raised and showed excellent functional and cosmetic results, with a mean follow-up of 31.7 months (range, 7-50 months). Conclusion: Chronic tophaceous gout can cause severe skin infection and necrosis, even resulting in deformity or sepsis if left untreated. Surgical debridement is inevitable in patients with extensive wounds. We reconstructed the large, ulcerative skin and soft-tissue defects on the dorsum of the foot by performing free-flap reconstruction after adequate debridement and achieved good functional and cosmetic results. {\circledC} C 2011 Wiley Periodicals, Inc.",
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author = "Chin-Ta Lin and Shun-Cheng Chang and Tim-Mo Chen and Niann-Tzyy Dai and Ju-Peng Fu and Shou-Cheng Deng and Yuan-Sheng Tzeng and Shyi-Gen Chen",
note = "被引用次數:2 Export Date: 21 March 2016 CODEN: MSRGD 通訊地址: Chen, S.-G.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件: shyigen@ms26.hinet.net 參考文獻: Landry, J.R., Schilero, J., The medical/surgical management of gout (1986) Journal of Foot Surgery, 25 (2), pp. 160-175; Lin, K.-C., Lin, H.-Y., Chou, P., The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study (2000) Journal of Rheumatology, 27 (6), pp. 1501-1505; Lee, S.S., Lin, S.D., Lai, C.S., Lin, T.M., Chang, K.P., Yang, Y.L., The soft-tissue shaving procedure for deformity management of chronic tophaceous gout (2003) Ann Plast Surg, 51, pp. 372-375; Larmon, W.A., Surgical management of tophaceous gout (1970) Clin Orthop Relat Res, 71, pp. 56-69; Ford, T.C., Surgical management of chronic tophaceous gout (1992) J Am Podiatr Med Assoc, 82, pp. 514-519; Ishikawa, K., Isshiki, N., Suzuki, S., Shimamura, S., Distally based dorsalis pedis island flap for coverage of the distal portion of the foot (1987) Br J Plast Surg, 40, pp. 521-525; Mathes, S.J., Nahai, F., (1979) Abductor Hallucis Muscle Flap. Clinical Atlas of Muscle and Musculocutaneous Flaps, pp. 269-277. , St Louis: CV Mosby;; Yoshimura, Y., Nakajima, T., Kami, T., Distally based abductor digiti minimi muscle flap (1985) Annals of Plastic Surgery, 14 (4), pp. 375-377. , DOI 10.1097/00000637-198504000-00012; Wee, J.T.K., Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: Preliminary report of a new fasciocutaneous flap (1986) British Journal of Plastic Surgery, 39 (3), pp. 327-337; Liu, K., Li, Z., Lin, Y., Cao, Y., The reverse-flow posterior tibial island flap: Anatomic study and 72 clinical cases (1990) Plast Reconstr Surg, 86, pp. 312-316; Yoshimura, M., Imura, S., Shimamura, K., Peroneal flap for reconstruction in the extremity: Preliminary report (1984) Plastic and Reconstructive Surgery, 74 (3), pp. 402-409; Ou, K.L., Tzeng, Y.S., Yu, C.C., Chen, T.M., Resurfacing tophaceous gout in the foot with anterolateral thigh flap (2010) Microsurgery, 30, pp. 79-82; Lee, K.S., Lee, H.S., Kim, N.G., Kim, J.S., Lee, S.I., Choi, T.H., Treatment of chronic tophaceous gout with a free flap (2010) Clin Rheumatol, 29, pp. 333-334; Chen, S.L., Chen, T.M., Lee, C.H., Free medial sural artery perforator flap for resurfacing distal limb defects (2005) J Trauma, 58, pp. 323-327; Shimizu, F., Kato, A., Sato, H., Taneda, H., Sural perforator flap: Assessment of the posterior calf region as donor site for a free fasciocutaneous flap (2009) Microsurgery, 29, pp. 253-258; Aydin, O.E., Tan, O., Kuduban, S.D., Barin, E.Z., Nerve sparing-distally based sural flap (2011) Microsurgery, 31, pp. 276-280; Wei, F.C., Jain, V., Celik, N., Chen, H.C., Chuang, D.C., Lin, C.H., Have we found an ideal soft tissue flap? An experience with 672 anterolateral thigh flaps (2002) Plast Reconstr Surg, 109, pp. 2219-2230",
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TY - JOUR

T1 - Free-flap resurfacing of tissue defects in the foot due to large gouty tophi

AU - Lin, Chin-Ta

AU - Chang, Shun-Cheng

AU - Chen, Tim-Mo

AU - Dai, Niann-Tzyy

AU - Fu, Ju-Peng

AU - Deng, Shou-Cheng

AU - Tzeng, Yuan-Sheng

AU - Chen, Shyi-Gen

N1 - 被引用次數:2 Export Date: 21 March 2016 CODEN: MSRGD 通訊地址: Chen, S.-G.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件: shyigen@ms26.hinet.net 參考文獻: Landry, J.R., Schilero, J., The medical/surgical management of gout (1986) Journal of Foot Surgery, 25 (2), pp. 160-175; Lin, K.-C., Lin, H.-Y., Chou, P., The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study (2000) Journal of Rheumatology, 27 (6), pp. 1501-1505; Lee, S.S., Lin, S.D., Lai, C.S., Lin, T.M., Chang, K.P., Yang, Y.L., The soft-tissue shaving procedure for deformity management of chronic tophaceous gout (2003) Ann Plast Surg, 51, pp. 372-375; Larmon, W.A., Surgical management of tophaceous gout (1970) Clin Orthop Relat Res, 71, pp. 56-69; Ford, T.C., Surgical management of chronic tophaceous gout (1992) J Am Podiatr Med Assoc, 82, pp. 514-519; Ishikawa, K., Isshiki, N., Suzuki, S., Shimamura, S., Distally based dorsalis pedis island flap for coverage of the distal portion of the foot (1987) Br J Plast Surg, 40, pp. 521-525; Mathes, S.J., Nahai, F., (1979) Abductor Hallucis Muscle Flap. Clinical Atlas of Muscle and Musculocutaneous Flaps, pp. 269-277. , St Louis: CV Mosby;; Yoshimura, Y., Nakajima, T., Kami, T., Distally based abductor digiti minimi muscle flap (1985) Annals of Plastic Surgery, 14 (4), pp. 375-377. , DOI 10.1097/00000637-198504000-00012; Wee, J.T.K., Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: Preliminary report of a new fasciocutaneous flap (1986) British Journal of Plastic Surgery, 39 (3), pp. 327-337; Liu, K., Li, Z., Lin, Y., Cao, Y., The reverse-flow posterior tibial island flap: Anatomic study and 72 clinical cases (1990) Plast Reconstr Surg, 86, pp. 312-316; Yoshimura, M., Imura, S., Shimamura, K., Peroneal flap for reconstruction in the extremity: Preliminary report (1984) Plastic and Reconstructive Surgery, 74 (3), pp. 402-409; Ou, K.L., Tzeng, Y.S., Yu, C.C., Chen, T.M., Resurfacing tophaceous gout in the foot with anterolateral thigh flap (2010) Microsurgery, 30, pp. 79-82; Lee, K.S., Lee, H.S., Kim, N.G., Kim, J.S., Lee, S.I., Choi, T.H., Treatment of chronic tophaceous gout with a free flap (2010) Clin Rheumatol, 29, pp. 333-334; Chen, S.L., Chen, T.M., Lee, C.H., Free medial sural artery perforator flap for resurfacing distal limb defects (2005) J Trauma, 58, pp. 323-327; Shimizu, F., Kato, A., Sato, H., Taneda, H., Sural perforator flap: Assessment of the posterior calf region as donor site for a free fasciocutaneous flap (2009) Microsurgery, 29, pp. 253-258; Aydin, O.E., Tan, O., Kuduban, S.D., Barin, E.Z., Nerve sparing-distally based sural flap (2011) Microsurgery, 31, pp. 276-280; Wei, F.C., Jain, V., Celik, N., Chen, H.C., Chuang, D.C., Lin, C.H., Have we found an ideal soft tissue flap? An experience with 672 anterolateral thigh flaps (2002) Plast Reconstr Surg, 109, pp. 2219-2230

PY - 2011

Y1 - 2011

N2 - Background: Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of complex soft-tissue defects of the foot is still challenging. The purpose of this report was to review the outcomes of free-flap reconstructive surgery for treating the metatarsal joint defects of the feet caused by chronic tophaceous gout. Methods: Ten patients who had large tophus masses (>5 cm) and ulceration on the feet were admitted to our hospital between September 2006 and September 2010. Six patients underwent free-flap reconstruction after debridement to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for exposed tendons. The patients' age, sex, comorbidities, location and size of the defects, reconstructive procedures, surgical outcomes, complications, follow-ups, and recurrence of tophaceous gout were reviewed and recorded. Results: The mean patient age was 49.8 years (range, 36-72 years). The average skin defect size was 92.2 cm 2. Five patients were treated using free anterolateral thigh flaps, and 1, using a free medial sural flap. These free flaps were safely raised and showed excellent functional and cosmetic results, with a mean follow-up of 31.7 months (range, 7-50 months). Conclusion: Chronic tophaceous gout can cause severe skin infection and necrosis, even resulting in deformity or sepsis if left untreated. Surgical debridement is inevitable in patients with extensive wounds. We reconstructed the large, ulcerative skin and soft-tissue defects on the dorsum of the foot by performing free-flap reconstruction after adequate debridement and achieved good functional and cosmetic results. © C 2011 Wiley Periodicals, Inc.

AB - Background: Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of complex soft-tissue defects of the foot is still challenging. The purpose of this report was to review the outcomes of free-flap reconstructive surgery for treating the metatarsal joint defects of the feet caused by chronic tophaceous gout. Methods: Ten patients who had large tophus masses (>5 cm) and ulceration on the feet were admitted to our hospital between September 2006 and September 2010. Six patients underwent free-flap reconstruction after debridement to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for exposed tendons. The patients' age, sex, comorbidities, location and size of the defects, reconstructive procedures, surgical outcomes, complications, follow-ups, and recurrence of tophaceous gout were reviewed and recorded. Results: The mean patient age was 49.8 years (range, 36-72 years). The average skin defect size was 92.2 cm 2. Five patients were treated using free anterolateral thigh flaps, and 1, using a free medial sural flap. These free flaps were safely raised and showed excellent functional and cosmetic results, with a mean follow-up of 31.7 months (range, 7-50 months). Conclusion: Chronic tophaceous gout can cause severe skin infection and necrosis, even resulting in deformity or sepsis if left untreated. Surgical debridement is inevitable in patients with extensive wounds. We reconstructed the large, ulcerative skin and soft-tissue defects on the dorsum of the foot by performing free-flap reconstruction after adequate debridement and achieved good functional and cosmetic results. © C 2011 Wiley Periodicals, Inc.

KW - adult

KW - age

KW - aged

KW - anterolateral thigh flap

KW - article

KW - clinical article

KW - comorbidity

KW - debridement

KW - feet tophaceous gout

KW - female

KW - free tissue graft

KW - gout

KW - human

KW - leg ulcer

KW - male

KW - medial sural flap

KW - patient safety

KW - priority journal

KW - sex difference

KW - skin necrosis

KW - skin ulcer

KW - surgical wound

KW - tarsometatarsal joint

KW - tendon

KW - treatment outcome

KW - Adult

KW - Aged

KW - Arthritis, Gouty

KW - Follow-Up Studies

KW - Foot Ulcer

KW - Gout

KW - Graft Survival

KW - Humans

KW - Male

KW - Microsurgery

KW - Middle Aged

KW - Retrospective Studies

KW - Sampling Studies

KW - Severity of Illness Index

KW - Skin Transplantation

KW - Surgical Flaps

KW - Taiwan

KW - Toes

KW - Treatment Outcome

KW - Wound Healing

U2 - 10.1002/micr.20949

DO - 10.1002/micr.20949

M3 - Article

VL - 31

SP - 610

EP - 615

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 8

ER -