Martin R
Ostomy/wound management. Date of publication 2004 Apr 1;volume 50(4):64-6, 68-70; discussion 71.
1. Ostomy Wound Manage. 2004 Apr;50(4):64-6, 68-70; discussion 71.
Mysterious calciphylaxis: wounds with eschar--to debride or not to debride?
Martin R(1).
Author information:
(1)Florida Hospital Wound, Ostomy, Continence, Team, Orlando, FL 32803, USA.
Rcoqui4@earthlink.net
Calciphylaxis is a confusing disease process that affects people with end-stage
renal disease. The prognosis of this increasingly common condition is poor and
mortality rates range from 60% to 80% related to wound infection, sepsis, and
organ failure. Its presenting sign is skin necrosis related to calcification of
the arteriole microvasculature. The disease is painful and debilitating,
particularly due to the necrotic wounds. Aggressive wound care to prevent
infection is vital when eschar does not protect the wound and drainage is
present, but debridement is contraindicated for wounds covered with dry,
noninfected eschars. The decision to debride is based on the patient's total
clinical picture. Patients with calciphylaxis have poor healing potential due to
ischemia and comorbidity factors such as diabetes mellitus, peripheral vascular
disease, and obesity. The goal of care is prevention of infection and pain
management. Some of the sensitizers and challengers responsible for the chemical
imbalance leading to the arteriole calcification, as well as risk factors and
clinical manifestations of calciphylaxis, are reviewed. A discussion of treatment
focuses on wound care of stable necrotic ulcers and a case report illustrating
the progression of calciphylaxis is presented.
PMID: 15259802 [Indexed for MEDLINE]
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