Gouty tophus without gout attacks treated using a reversed digital artery flap

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Pathology

Background:

• Subcutaneous masses on digits can mimic soft tissue tumors, necessitating accurate preoperative diagnosis.
• Tophaceous gout is a manifestation of chronic hyperuricemia, often presenting with urate crystal deposition in soft tissues.

Observation:

• A patient presented with a subcutaneous finger mass, clinically suspected to be a soft tissue tumor.
• Excision biopsy and digital artery flap reconstruction were performed for the mass.

Findings:

• Pathological examination confirmed the mass as tophaceous gout.
• The patient had no documented history of previous gout attacks, complicating the initial clinical suspicion.

Implications:

• This case underscores the importance of considering tophaceous gout in the differential diagnosis of digital soft tissue masses, even without a prior gout history.
• Accurate preoperative diagnosis is crucial for appropriate surgical planning and patient management.
• Digital artery flap reconstruction is a viable option for soft tissue defects following mass excision.