En Masse Excision and Curettage for Periarticular Gouty Tophi of the Hands

Matthew Doscher, MD, FACS; Bryan G Beutel, MD; Andrew Lovy, MD; Brandon Alba, MD, MPH; Charles Melone, MD, FACS, FAOA


ePlasty. 2022;22(e25) 

In This Article

Methods and Materials

A retrospective review was conducted of all consecutive patients who underwent surgical excision of tophaceous deposits from the upper extremity. All patients had an established diagnosis of gout and had been treated with urate-lowering medication. All tophi were substantive in size and were causing notable digital joint dysfunction with variable skin ulcerations. The tophi were also a source of considerable disfigurement. In all cases, tophi were excised en masse and underlying tendons and joint capsules were curetted and repaired when necessary. Similarly, residual deposits in the overlying skin were either curetted or excised. Primary wound closure with local flap advancement was achieved in all cases. Postoperatively, the patients were typically evaluated in the office approximately 4 times within the first 2 weeks, during which time the surgical wounds were carefully assessed and cleaned with hydrogen peroxide, and the flaps were spread and drained of underlying hematoma (as needed) in order to maximize perfusion to facilitate healing.