[Comprehensive management of tophaceous wound].

Area of Science:

• Rheumatology
• Dermatology
• Wound Care

Background:

• Tophaceous wounds are severe, non-healing ulcers in end-stage gout, caused by monosodium urate (MSU) crystal deposition.
• Pathologically, MSU crystals lead to ischemia, inflammation, and vascular compression from tophi, causing chronic wounds.
• Persistent hyperuricemia is the underlying driver of MSU crystal formation and tophus development.

Purpose of the Study:

• To consolidate evidence for an integrated management strategy for tophaceous wounds.
• To outline a combined approach of systemic metabolic control and localized wound interventions.
• To improve prognosis for patients suffering from these complex wounds.

Main Methods:

• Systemic control: Maintaining serum uric acid <300 μmol/L with urate-lowering agents (e.g., AR882) and anti-inflammatories (NSAIDs, glucocorticoids).
• Localized treatment: Topical agents, advanced dressings, and debridement (sharp, ultrasonic, micro-techniques) to remove MSU deposits and necrotic tissue.
• Surgical interventions: Flap transfers and reconstruction for significant tissue loss or functional impairment.

Main Results:

• Effective management combines metabolic normalization with targeted local therapies.
• Debridement efficacy can be monitored via local uric acid levels.
• Surgical options address structural damage and functional deficits.

Conclusions:

• Comprehensive treatment necessitates multidisciplinary collaboration for optimal outcomes.
• Long-term management requires continuous metabolic control, rehabilitation, and lifestyle adjustments.
• Future research includes gene therapy and AI for precision medicine in tophaceous wound care.