Calciphylaxis-associated pannicular wounds in end-stage renal disease: Recurrent disease, massive adipose necrosis, and eventual resolution through multidisciplinary management
DOI:
https://doi.org/10.63676/nbsgz173Keywords:
Calciphylaxis, ESRD, sodium thiosulfate, panniculus, adipose necrosis, NPWTAbstract
Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare but life-threatening microvascular condition marked by arteriolar calcification, thrombosis, and progressive ischemic tissue necrosis. Mortality rates range from 45–80%, most commonly due to wound-related sepsis.
Methods: Retrospective clinical data were extracted from wound center documentation for a 56-year-old woman with end-stage renal disease (ESRD) on dialysis who developed recurrent calciphylaxis-associated pannicular wounds. Care was organized using a structured 7-step wound management approach employed by our clinical team (etiology/perfusion; infection control; debridement; metabolic/nutritional optimization; off-loading/mechanical protection; dressing/host optimization; and advanced modalities such as negative pressure wound therapy (NPWT)). A coordinated multidisciplinary approach included nephrology-guided metabolic optimization, surgical debridement, and NPWT as the principal advanced wound modality.
Results: The patient developed extensive coalescent necrosis with liquefactive adipose degeneration requiring aggressive surgical debridement, NPWT, and later transition to selected antimicrobial dressings during epithelialization.
Conclusion: Severe recurrent calciphylaxis in adipose-rich regions can achieve full healing through coordinated multidisciplinary management integrating systemic optimization, operative intervention, and structured wound care.
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