A survey of indications, results and complications of surgery for tophaceous XXXX .

@entity1 @entity8 @entity295 @entity101 @entity6 @entity158 @entity299 @entity1011 @entity210 @entity208 @entity446 @entity414
AIMS: To document the indications, results and complications associated with surgery for tophaceous @entity210 in Middlemore Hospital. METHODS: A retrospective study of the notes of all @entity1 who underwent surgery for tophaceous @entity210 at Middlemore Hospital from July 1995 to July 2001 was performed. Serum @entity1011 and @entity414 results were obtained and the use of @entity208 assessed. RESULTS: 45 @entity1 underwent surgery for gouty tophi. 89% were males and 11% females. 16% were Maori, 38% Pacific @entity1 , 42% Europeans and 4% were from other ethnic backgrounds. @entity8 (serum @entity1011 . >0.11 mmol/L) was the most common associated medical problem (38%), followed by @entity101 (27%), @entity299 and/or congestive @entity299 (20%) and @entity6 (18%). 68% of @entity1 had elevated serum urate levels (>0.42 mmol/L) and only 31% had previously been taking @entity208 . Sepsis control in infected or ulcerated tophi was the main indication for surgery (51%), followed by mechanical problems caused by foot, elbow and hand tophi (27%). The diagnosis of soft tissue masses was unclear in 18% of the @entity1 prior to surgery. 4% of @entity1 underwent tophus surgery mainly for @entity158 control. 53% of @entity1 experienced delayed wound @entity446 as a result of complications of surgery with the majority of these @entity1 (16/24, 67%) having infected or ulcerated tophi prior to surgery. Three @entity1 (7%) required digital amputations for ongoing @entity295 . 47% of @entity1 did not have any complication of surgery and had complete wound @entity446 within one week. CONCLUSIONS: Surgery for tophaceous @entity210 is associated with a relatively high rate of complication when @entity295 is the main indication. @entity1 with @entity210 in this study population had several associated medical co-morbidities, which contributed to the high complication rate. Gout control was poor as evidenced by a high rate of hyperuricaemia, and less than one third of the study population were on @entity208 . Better control of @entity210 would reduce the risk of tophi formation and the need for surgery.
