A retrospective analysis of the surgical efficacy for tophi wounds in Hainan province

IntroductionGouty tophi are chronic inflammatory nodules resulting from monosodium urate (MSU) crystal deposition, often leading to joint deformity, skin ulceration, and functional impairment. Surgical management remains controversial due to a lack of standardized indications. This study aimed to evaluate the efficacy of surgical treatment for gouty tophi wounds and to explore surgical indications.MethodsThis retrospective study consecutively enrolled patients with gouty tophi wounds who underwent surgical treatment at the First Affiliated Hospital of Hainan Medical University, a tertiary hospital in Haikou, Hainan Province, China, between April 2018 and April 2024. Clinical data, including demographic characteristics, infection markers, nutritional parameters, and surgical outcomes, were collected from electronic medical records and paper-based patient charts. Perioperative changes in these indicators were analyzed. The study was reported in accordance with the STROBE guidelines.ResultsA total of 130 patients were included, comprising 129 males (99.2%) and 1 female (0.8%), with a mean age of 58.15 ± 14.04 years. The primary comorbidities included hypertension (43.85%), diabetes mellitus (13.85%), renal insufficiency (11.54%), and hyperlipidemia (8.46%). The primary surgical modalities were lesion excision (41.54%), debridement (34.62%), and vacuum sealing drainage (VSD) (23.08%). Wound healing was achieved in 124 cases (95.38%), with a mean healing time of 31.43 ± 16.18 days; 5 cases (3.85%) failed to heal, and 1 patient (0.77%) died from multiorgan failure. The positive microbiological culture rate decreased from 21 cases (16.15%) preoperatively to 1 case (0.77%) postoperatively, with Staphylococcus aureus (28.57%) being the predominant preoperative pathogen. Postoperative laboratory parameters showed significant reductions in white blood cell count (WBC, P < 0.05), neutrophil count (NE, P < 0.001), blood urea nitrogen (BUN, P < 0.001), uric acid (P < 0.001), and creatinine (P < 0.001) compared with preoperative values. Albumin levels increased slightly (P > 0.05), while prealbumin levels rose significantly (P < 0.001). Pain scores assessed by the Faces Pain Scale-Revised (FPS-R, P < 0.001) and the Changhai Pain Scale (P < 0.001) also demonstrated marked postoperative declines.DiscussionSurgical management of gouty tophi wounds is associated with favorable wound healing, significant systemic anti-inflammatory and metabolic benefits, and effective pain relief. The low infection rate in ulcerated tophi supports the bacteriostatic role of MSU crystals. Based on these findings, surgical indications include functional impairment, chronic non-healing wounds, refractory pain, and large tophi (>1.5 cm) impeding daily activities. Surgery should be avoided during acute gout flares and in high-risk patients with uncontrolled comorbidities.