THE UREMIC GANGRENE SYNDROME - IMPROVED HEALING IN SPONTANEOUSLY FORMING WOUNDS FOLLOWING SUBTOTAL PARATHYROIDECTOMY

Patients with end-stage renal disease often demonstrate retarded heali ng of surgical wounds, but the basis for spontaneous wound formation i n these patients is less well understood. We report our experience wit h four patients with a unique clinical entity previously described as the uremic gangrene syndrome (also known as calciphylaxis) that involv es spontaneously forming and insidiously progressive wounds of the ski n and soft tissue in uremic patients with hyperparathyroidism. The imp ortance of recognizing this phenomenon relates to the potential benefi t to wound-healing efforts resulting from subtotal parathyroidectomy a nd adjustment of serum calcium and phosphate levels when severe hyperp arathyroidism is present. Disrupted parathyroid homeostasis as a mecha nism for soft-tissue ischemia and subsequent infarction is supported b y wound biopsies demonstrating microarterial calcification. As experts in factors resulting in refractory wounds, plastic surgeons need be a ware of this peculiar vulnerability for spontaneously forming wounds i n uremic patients. Clinical and laboratory findings, success with woun d treatment in four patients, and currently popular pathophysiologic m echanisms are discussed.