Resurfacing Tophaceous Gout in the Foot with a Medial Sural Artery Perforator Flap

Abstract

Background: Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of the complex soft tissue defect in the foot is still challenging.Aim and Objectives:We reconstructed a large ulcerative skin and soft tissue defect of dorsal foot secondary to chronic tophaceous gout by a free medial sural perforator flap after series of debridement of the infectious wound. A literature review of reconstructions of ulcerative skin and soft tissue defects of dorsal foot is discussed.Materials and Methods: A 39-year-old man had persistent chronic tophaceous gout, with skin necrosis between the 4(superscript th) and 5(superscript th) tarsometatarsal joints of the dorsum of the right foot. The patient was referred to our hospital after an initial debridement at a local clinic and the wound defect on the right foot was approximately 5.5 × 3.5 cm in size. After debridement, we designed a medial sural artery perforator flap (size, 8 × 4.5 cm), which was raised from his right calf to restore the soft tissue defect.Results:Postoperative course was uneventful without observed postoperative complications, such as compromised flap pedicle, vascular thrombosis, hematoma, and wound infection or dehiscence. The patient was instructed to follow a controlled diet, exercise regularly, and take regular medications to control gout and prevent the recurrence of the tophaceous masses. The thin flap was completely viable after surgery and showed good survival and aesthetic outcome at the 3-month follow-up.Conclusion:Chronic tophaceous gout can cause severe extensive infection and skin necrosis, and can even result in deformity or sepsis if left untreated. Surgical debridement becomes inevitable when the infected necrotized wound is located over a tophaceous mass. In this case, after the initial debridement, we performed a medial sural perforat or flap for his large ulcerative skin and soft-tissue defects on the dorsum of the foot, which were secondary to chronic tophaceous gout, and achieved good functional and cosmetic results.