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Dressings for ulcers with gouty tophi?

Discussion in 'General Issues and Discussion Forum' started by mifiros, Apr 13, 2008.

  1. mifiros

    mifiros Member

    Members do not see these Ads. Sign Up.
    I have a patient whose 1st toe joints are severely affected by gout. At the moment he has an ulcer that is being dressed by our team once a week and sometimes by himself during the week, if he can't tolerate the dsg on for more than 7 days (he c/o quite significant amount of pain). The wound exudes gouty tophi, which seem to prevent healing. Are there any particular dsgs that would help? At the moment he is on allpurinol. He used to be on indomethacin, but it was discontinued due to having affected his kidneys.

    Many thanks,
  2. adavies

    adavies Active Member


    Allpurinol is good for preventative measures but will exacerbate attacks of gout.

    Kiwi AD
  3. Ella Hurrell

    Ella Hurrell Active Member

    Yes, I thought Allopurinol was contra-indicated during an acute gout attack, and that Diclofenac was the treatment of choice?

    As for dressings, you don't mention what is being used at the moment? Perhaps when I know that, I can suggest something else?
  4. mifiros

    mifiros Member

    Hi Ella,

    Thanks for your message. I will check with the pt's GP and see if his medication needs altering. The dsg used at the moment is plain Allevyn, as the base of the ulcer is healthy (apart from the tophi, which can be removed easily), although Iodoflex has been used together with Allevyn in the past. I look forward to your recommendations.

    Kind regards,
  5. drsarbes

    drsarbes Well-Known Member


    Is your patient a surgical candidate? You may be doomed to failure if his tophi are seeking an egress.
    There are times, I'm sure we've all seen them, where the amount of tophaceous deposits is so large that the skin is literally tissue paper thin.
    These need to be debrided of as much tophi as possible to have any chance of long term closure.

  6. Ella Hurrell

    Ella Hurrell Active Member

    Do you think that the Allevyn is just sticking to the wound after 7 days and causing the pain, or do you think the pain is more to do with the gouty joint itself? I don't think I'd leave Allevyn on for more than a week anyway - perhaps trying something like mepitel and mepilex together? But I think Steve has made a good point - sometimes it doesn't matter what you put on it, if the deposits are so large, you haven't much hope of healing it without further medical intervention. It'd be interesting to know what the GP says re medications. I guess someone's been over the dietary considerations of gout and that your patient is not indulging in foods that will exacerbate his gout?

    Good luck - let us know how he gets on.

  7. mifiros

    mifiros Member

    Hello Ella

    Thanks for your reply. I'm seeing this pt tomorrow and I look forward to seeing the wound. I personally think the pain is coming from the gouty joint itself, plus the ulcer (he is not neuropathic) rather than the allevyn sticking on the wound. The dsg is changed at least once week (as he sometimes dresses it himself- albeit inappropriately :craig:)

    I don't know about his dietary habits- he is certainly not the slimmest of people. I will talk to him about that and drop a letter to his GP regarding his medication and possible surgical intervention.

    Many thanks for everyone's precious advice!

  8. bunion

    bunion Member

    Ive had good results with polymem Silver polymem if secondary infection.
  9. Jbwheele

    Jbwheele Active Member

    Hi MAte,

    Is the ulcer healed yet? Is it getting rubbed by the shoe ? Felt offloading often helps to eliminate local irritation or ischaema.


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