Dystrophic calcification in chronic leg ulcers--a clinicopathologic study.
BACKGROUND
Dystrophic calcification (DC) is a risk factor for conservative treatment failure in chronic leg ulcers of various pathologies.


METHODS
We performed a retrospective noncontrolled trial of 212 patients with 362 chronic leg ulcers who underwent ulcer shave excision with subsequent skin grafting. The ulcers existed for at least 3 months, and no healing was achieved with good ulcer care. Tissue was subjected to histopathology (hematoxylin-eosin and van Kossa stains).


RESULTS
DC was evident in 39 patients (18%). Metaplastic subcutaneous bone formation was observed in 15 patients (7%). Clinical symptoms associated with DC were resistance to good ulcer care, pain, and ineffective effects of compression therapy (in venous ulcers). Ulcers were treated with deep dermatome shaving of the ulcer bed and surgical removal of DC. In the same setting, defects were closed using mesh graft transplantation. The procedure achieved a complete take rate in 80% and a significant decrease of pain in 95% of cases. When comparing the take rates in patients with and without DC, DC had a negative effect on outcome (take rate: 91% without DC vs 80% with DC, p<.05).


CONCLUSIONS
DC is resistant to conservative treatment. The first-line treatment is deep ulcer dermatome shaving and complete removal of calcifications whenever possible.
Wollina
Uwe
U
Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany. wollina-uw@khdf.de
Hasenöhrl
Kristin
K
Köstler
Erich
E
Schönlebe
Jaqueline
J
Heinig
Birgit
B
Haroske
Gunther
G
Kittner
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012594:Scleroderma, Localized / Q000473:pathology / Q000601:surgery; D016038:Skin Transplantation