Kane W J, Petty P M, Sterioff S, McCarthy J T, Crotty T B
Department of Plastic and Reconstructive Surgery, Mayo Graduate School of Medicine, Rochester, Minn, USA.
Plast Reconstr Surg. 1996 Sep;98(4):671-8. doi: 10.1097/00006534-199609001-00011.
Patients with end-stage renal disease often demonstrate retarded healing of surgical wounds, but the basis for spontaneous wound formation in these patients is less well understood. We report our experience with four patients with a unique clinical entity previously described as the uremic gangrene syndrome (also known as calciphylaxis) that involves spontaneously forming and insidiously progressive wounds of the skin and soft tissue in uremic patients with hyperparathyroidism. The importance of recognizing this phenomenon relates to the potential benefit to wound-healing efforts resulting from subtotal parathyroidectomy and adjustment of serum calcium and phosphate levels when severe hyperparathyroidism is present. Disrupted parathyroid homeostasis as a mechanism for soft-tissue ischemia and subsequent infarction is supported by wound biopsies demonstrating microarterial calcification. As experts in factors resulting in refractory wounds, plastic surgeons need be aware of this peculiar vulnerability for spontaneously forming wounds in uremic patients. Clinical and laboratory findings, success with wound treatment in four patients, and currently popular pathophysiologic mechanisms are discussed.
终末期肾病患者的手术伤口愈合常常延迟，但这些患者自发伤口形成的原因尚不太清楚。我们报告了4例患有一种独特临床病症的患者的情况，该病症先前被描述为尿毒症坏疽综合征（也称为钙化防御），涉及甲状旁腺功能亢进的尿毒症患者皮肤和软组织的自发形成且隐匿进展的伤口。认识到这一现象的重要性在于，当存在严重甲状旁腺功能亢进时，甲状旁腺次全切除术以及调整血清钙和磷水平可能有助于伤口愈合。伤口活检显示微动脉钙化，这支持了甲状旁腺内环境紊乱作为软组织缺血及随后梗死的一种机制。作为难治性伤口相关因素方面的专家，整形外科医生需要意识到尿毒症患者自发形成伤口的这种特殊易感性。本文讨论了临床和实验室检查结果、4例患者伤口治疗的成功经验以及当前流行的病理生理机制。
