Press Release

Best in Class: Scottsdale Wound Management Guide

Comprehensive pocket handbook offers differential diagnosis and treatment options at your fingertips

Malvern, PA (June 8, 2009) – Proper wound care management has become one of the top concerns for many clinicians across various medical specialties. Treatment is specific to the wound type, the patient and the long-term care plan and requires ongoing assessment. Read More

Commentary on The Mysterious Calciphylaxis: Wounds with Eschars - To Debride or Not to Debride?

VOLUME: 50
Issue Number: 
4
author: 
Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN

A s the author of this manuscript suggests, calciphylaxis is certainly a mysterious and confusing disorder and no longer uncommon. As more Americans with end-stage renal disease (ESRD) survive for longer time periods on dialysis, the occurrence of calciphylaxis is increasing. One of the greatest challenges associated with the disorder is the fact that its pathomechanisms are not fully understood and its treatment is controversial.
A major appropriate theme in this article is treatment of calciphylaxis in the context of the patient's situation. Because the condition and necrosis emerge over time, a patient's total status and ultimate prognosis may be poor. Although a clinician's first inclination is to arrange for prompt wound debridement of the sometimes substantial necrosis that occurs, caution is warranted. The trauma of surgery has been theorized as a potential "trigger" for the calcification process, so clinicians may be "between a rock and a hard place" (no pun intended).
In this author's experience, sharp debridement may not be the appropriate first step. Rather, patients may better tolerate slower enzymatic debridement because of lessened associated pain. Clinicians have to remember that the causes and treatments of calciphylaxis necrosis differ from the more common etiologies and approached to peripheral vascular disease.
Another aspect of the manuscript that deserves mention is the statement about "controlling and eliminating sensitizers and challengers." Clinicians have to view with caution an absolutist approach to this goal because the pathophysiology of calciphylaxis is still not fully understood. For an ESRD patient with severe anemia or protein depletion, blood transfusion or albumin therapy may be necessary. However, they are considered "challengers." Likewise, dialysis itself may be a form of sensitizer. Yet it cannot be stopped for persons requiring it. No easy answers emerge from the treatment of this disorder.
A final comment is warranted. The author's focus on early recognition and treatment of calciphylaxis is on target. Surgical approaches like parathyroidectomy, if enacted early, may slow the development process for some patients. The challenge is prompt recognition. Calciphylaxis may be difficult to correctly diagnose, especially if the patient has received intensive medical and surgical therapy. Other disorders can create necrosis in patients, including heparin-induced thrombocytopenia (HIT) necrosis and coumadin necrosis, among others. End-stage renal disease patients may receive these agents, and differential diagnosis may be involved and highly complex.
One thing about calciphylaxis is certain: it is increasing in incidence. Wound care clinicians can expect to encounter patients with the disorder and are likely to be challenged to the fullest degree of their expertise to provide quality care. Comprehensive understanding of the condition's etiology and its treatment uncertainties will make that a more likely reality.

Posted by Anonymous on August 20, 2009 at 11:08 am

Great comments and thank you for the clarity Dr. Beitz that calciphylaxis is no loner an uncommon condition. It can be very challenging identifing vascular ulcers from calciphylais; knowing the patients underlining condition can help.

T. Maria Jones, BS, RN, CWOCN

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Lines and paragraphs break automatically.

More information about formatting options

CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Copy the characters (respecting upper/lower case) from the image.





OWM Monthly Poll





All Subscriptions are FREE to qualified wound care professionals

OWM

  • Subscribe to:
  • Journal
  • Digital Journal
  • E-News
  • RSS feed

CLICK HERE TO CONTINUE »

Sage Online Library



REVIEW OUR OTHER
WOUND CARE BRANDS

Check out our other resources for healthcare professionals of all specialties.

  • WOUNDS
  • today's wound clinic
  • Podiatry Today
  • Skin and Aging