title: Heterotopic ossificans in chronic venous insufficiency: a new consideration for clinical, aetiology, anatomy and pathophysiology staging.
abstract: OBJECTIVE
  Heterotopic ossification is defined as the abnormal formation of true bone within extra-skeletal soft tissues. It may be associated with a variety of clinical conditions, but is most frequently seen with musculoskeletal trauma, neurologic injury or genetic abnormalities. It has also been described in patients with chronic venous insufficiency; however, it often goes underdiagnosed due to chronic ulceration that masks exam findings. To date, few reports of heterotopic ossification due to chronic venous disease exist within the literature with the most recent dating back to the 1970s.
  
  
  METHODS
  We present a case study of a man presenting with extensive leg ulceration and a history of chronic venous insufficency. He had a large non-healing venous stasis ulcer of the left lower extremity with extensive heterotopic ossification discovered intraoperatively.
  
  
  RESULTS
  The patient was managed with serial wound debridement, innovative woundcare and eventual split thickness skin grafting that achieved limb salvage despite the complexity of his wound.
  
  
  CONCLUSIONS
  Our discussion focuses on the epidemiology, pathophysiology, diagnostic work-up and management of heterotopic ossification in the setting of chronic venous insufficiency. We propose that heterotopic ossification be included in any future modifications of the clinical, aetiology, anatomy and pathophysiology system classification as a complication of chronic venous disease.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859, USA. danielle.cafasso@us.army.mil
authors.forename: D E
authors.initials: DE
authors.lastname: Cafasso
authors.forename: D K
authors.initials: DK
authors.lastname: Bowen
authors.forename: S A
authors.initials: SA
authors.lastname: Kinkennon
authors.forename: M D
authors.initials: MD
authors.lastname: Stanbro
authors.forename: D C
authors.initials: DC
authors.lastname: Kellicut
mesh_terms: D002908:Chronic Disease; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014689:Venous Insufficiency / Q000150:complications / Q000473:pathology / Q000601:surgery