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Calciphylaxis Wound Care Conservative — ESENeph MCQ

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ModerateHaemodialysisCalciphylaxis Wound Care ConservativeESENeph

A 60-year-old man with CKD G5D on HD develops calciphylaxis. His wounds are managed by a multidisciplinary team. The tissue viability nurse asks about debridement. What is the wound care approach?

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Correct answer: A — Conservative wound care with gentle debridement of clearly necrotic tissue only – aggressive surgical debridement is generally avoided as it can extend the wounds and worsen outcomes; moist wound healing, pain management, and infection prevention are priorities

Calciphylaxis wound management is a specialist area requiring multidisciplinary input (nephrology, dermatology, tissue viability, pain team, vascular surgery). Key principles: (1) gentle/conservative debridement of clearly necrotic tissue – aggressive surgical debridement often extends wounds (the surrounding tissue is also compromised by calcification); (2) moist wound healing environment (hydrogel, alginate, foam dressings); (3) infection prevention/early treatment; (4) adequate pain management (often requiring opioids); (5) nutritional optimisation; (6) sodium thiosulphate; (7) avoid tissue trauma. Hyperbaric oxygen has anecdotal support but limited evidence.

Reference: UKKA 2019 – Calciphylaxis; Nigwekar et al 2018 – Calciphylaxis Management