Difficult-to-heal ulcers in patients with tophaceous gout?

Gout, this ancient disease, still plagues many people in modern society. Many people with gout experience the formation of tophi, which may gradually increase in size over time. During this process, the skin becomes thinner and shiny due to the expansion of tophi, and yellow-white tophi dots are exposed. When urate crystals erode the skin, tophi eventually bursts the skin, forming chronic sinus tracts and stubborn ulcers. These ulcers ooze a milky white substance that is neither smelly nor fishy and has a shape similar to beach sand or the texture of toothpaste.

Once tophi breaks, the wound is often difficult to heal. Especially for tophi in the feet, it is even more difficult to heal the wounds due to poor blood supply in the feet and easy wear and tear. In severe cases, the joint may be eroded to the point of requiring amputation.

Why is it difficult to heal tophaceous tophi ulcers?

1. The skin around tophi has been irritated and eroded for a long time, causing blood vessels to be unable to provide sufficient nutrients to promote cell regeneration.

2. Urate crystals continue to leak out from the ulcerated wound, irritating the surrounding skin tissue and affecting healing.

3. After tophi rupture, secondary infection is easy to occur and gradually evolves into chronic inflammation, further hindering healing.

How to deal with ulcerated tophi wounds?

The first thing to note is that these wounds are best treated by professional medical staff to avoid infection caused by self-treatment. For mild wounds, you can use iodophor solution to flush and disinfect the wound initially, then clean it with hydrogen peroxide, and finally rinse it thoroughly with normal saline. This will remove as much yellow necrotic tissue and uric acid stones as possible. If the wound is mildly infected, you should go to a regular hospital for treatment immediately.

Treatment of moderate to severe wounds :

When the wound is deep, accompanied by cellulitis and a large amount of discharge, this usually means moderate ulceration. For wounds of this magnitude, it is recommended that patients go to a specialist hospital for treatment to avoid misleading the wound from worsening.

If the wound continues to worsen within a week after treating a moderate ulcer, with deep ulceration, bone tissue destruction, and obvious infection, it may have developed into a severe ulcer. At this time, it is recommended that the patient go to a regular specialist hospital as soon as possible to remove crystalline salt tophi through minimally invasive traditional Chinese medicine video acupuncture.

In the process of treating moderate to severe tophi ulcerated wounds, musculoskeletal ultrasound examination can help understand the distribution of uric acid crystal salts and the degree of destruction of soft tissue, synovium, and bone.

When it comes to tophi, prevention is far more important than treatment. Tophi should not be allowed to grow until they rupture, as this can cause great physical and mental suffering to the patient. At this time, family members should help patients regain their confidence in treatment and give them the courage to face and overcome this disease.

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Editor: kiki Jia

Date: January 21, 2023