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Surgical management of pain or infection secondary to calciphylaxis: a wound center's experience and algorithmic multidisciplinary approach.

MedStar author(s):

Akbari, Cameron M

, MHVI

Margulies, Ilana

, MGUH

, Plastic Surgery Residency

Steinberg, John

, MWHC

1044-7946

Name of journal: Wounds : a compendium of clinical research and practiceAbstract: BACKGROUND: The role of surgical management of calciphylaxis remains understudied.CONCLUSION: While the morbidity and mortality associated with calciphylaxis are substantial, surgical excision is effective in reducing pain and improving quality of life in patients with this end-stage disease. Wound care centers are uniquely equipped with a variety of medical and surgical specialists with experience in treating chronic wounds and thus facilitate an efficient multidisciplinary model.METHODS: A single-center retrospective review of all adult patients with calciphylaxis treated surgically between January 2010 and November 2022 was performed.OBJECTIVE: This article reports a case series and algorithmic approach to the multidisciplinary management of calciphylaxis.RESULTS: Eleven patients met inclusion criteria. The average age was 50.9 years +/- 15.8 SD, and most patients were female (n = 7 [63.6%]). Surgery was indicated for infection (n = 6 [54.5%]) and/or intractable pain (n = 11 [100%]). Patients underwent an average of 2.9 excisional debridements during their hospital course. Following the final excision, wounds were left open in 5 cases (29.4%), closed primarily in 4 (23.5%), and local flaps were used in 3 (27.3%). Postoperatively, the mean time to healing was 57.4 days +/- 12.6. Complications included dehiscence (n = 1 [9.1%]), progression to cellulitis (n = 2 [18.2%]), osteomyelitis (n = 1 [9.1%]), and lower extremity amputation (n = 2 [18.2%]). Of the 6 patients alive at the time of healing, 5 (83.3%) were no longer taking narcotic medications. At an average follow-up of 26.4 months +/- 34.1, 7 patients (63.6%) were deceased, with an average time to mortality of 4.8 months +/- 6.7. Of the 4 remaining patients, 3 (75.0%) were ambulatory by their most recent follow-up visit.All authors: Berger LE, Bell AC, Huffman SS, Spoer DL, Margulies IG, Kim KG, Akbari CM, Steinberg JS, Attinger CE, Evans KKFiscal year: FY2024 Digital Object Identifier:

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Date added to catalog: 2024-01-16

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	37956343	Available		37956343

BACKGROUND: The role of surgical management of calciphylaxis remains understudied.

CONCLUSION: While the morbidity and mortality associated with calciphylaxis are substantial, surgical excision is effective in reducing pain and improving quality of life in patients with this end-stage disease. Wound care centers are uniquely equipped with a variety of medical and surgical specialists with experience in treating chronic wounds and thus facilitate an efficient multidisciplinary model.

METHODS: A single-center retrospective review of all adult patients with calciphylaxis treated surgically between January 2010 and November 2022 was performed.

OBJECTIVE: This article reports a case series and algorithmic approach to the multidisciplinary management of calciphylaxis.

RESULTS: Eleven patients met inclusion criteria. The average age was 50.9 years +/- 15.8 SD, and most patients were female (n = 7 [63.6%]). Surgery was indicated for infection (n = 6 [54.5%]) and/or intractable pain (n = 11 [100%]). Patients underwent an average of 2.9 excisional debridements during their hospital course. Following the final excision, wounds were left open in 5 cases (29.4%), closed primarily in 4 (23.5%), and local flaps were used in 3 (27.3%). Postoperatively, the mean time to healing was 57.4 days +/- 12.6. Complications included dehiscence (n = 1 [9.1%]), progression to cellulitis (n = 2 [18.2%]), osteomyelitis (n = 1 [9.1%]), and lower extremity amputation (n = 2 [18.2%]). Of the 6 patients alive at the time of healing, 5 (83.3%) were no longer taking narcotic medications. At an average follow-up of 26.4 months +/- 34.1, 7 patients (63.6%) were deceased, with an average time to mortality of 4.8 months +/- 6.7. Of the 4 remaining patients, 3 (75.0%) were ambulatory by their most recent follow-up visit.

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