Dear Editors
In the recent issue of the International Wound Journal Enoch et al. provided an excellent overview on calcification of tissue with particular emphasis on dystrophic calcification and of ossification in leg ulcers (1). Dystrophic calcification was defined as calcification due to local tissue injury and/or a persisting local abnormality such as a wound. Three case reports and a review on literature were given. One of the author's conclusions was that surgical removal of calcium deposits is of limited value.
Our experience at the Department of Dermatology, Hospital Dresden‐Friedrichstadt is somewhat different. Our department is one of the units that work together in the Vascular Centre together with the Department of Vascular Surgery and the Department of Angiology of the Internal Medicine Branch. We perform about 200 leg ulcer surgeries per year, mostly with subsequent skin grafting. In about 50% of the longstanding venous and mixed arterio‐venous leg ulcers we found different degrees of dystrophic calcification from mild symptoms mostly evident in histopathology to the extensive formation of scar bones.
In our department the procedure of choice is the removal of dystrophic calcification during the ulcer shaving procedure. We prefer the deep shaving in general anaesthesia mostly with a single shot intravenous antibiosis in the operation theatre. Calcification may involve all tissue layers from subcutaneous dermal to subcutaneous fat tissue and even the muscle fascia. In stage IV of the venous compression syndrome according to Hach (2), fascia involvement is common. In such cases, the deposits have to be removed with forceps and a curved scissor. Shaving alone is not sufficient under these circumstances. After careful treatment of bleeding the defect is usually closed by mesh graft transplantation. In our hands the procedure leads to complete ulcer healing in more than 80% of cases and to a significant relief from pain. This is in accordance with some other authors 3, 4, 5). Recurrence can be seen if there is another or an additional cause different from the chronic wound alone, e.g. renal disease. Ulcer surgery has to be completed by phlebosurgery to ensure good long‐term results. This is done by an interdisciplinary approach.
References
- 1. Enoch S, Kupitz S, Miller DR, Harding KG. Dystrophic calcification as a cause for non healing leg ulcers. Int Wound J 2005;2: 142–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Hach W, Prave E, Hach‐Wunderle V, Sterk J, Martin A, Willy C, Gerngross H. The chronic venous compartment syndrome. Vasa 2000;29: 127–32. [DOI] [PubMed] [Google Scholar]
- 3. Ebrahim MK, Kanjoor JR, Bang RL. Heterotopic calcification in burn scars and non‐healing ulcers. Burns 2003;29: 461–8. [DOI] [PubMed] [Google Scholar]
- 4. Milas M, Bush RL, Lin P, Brown K, Mackay G, Lumsden A, Weber C, Dodson TF. Calciphylaxis and nonhealing wounds: the role of the vascular surgeon in a multidisciplinary treatment. J Vasc Surg 2003;37: 501–7. [DOI] [PubMed] [Google Scholar]
- 5. Pathy AL, Rae V, Falanga V. Subcutaneous calcification in venous ulcers: report of a case. J Dermatol Surg Oncol 1990;16: 450–2. [DOI] [PubMed] [Google Scholar]