Treatment of Heterotopic Calcification with Ulceration in Burn Scar.

Kang, Sang Gu; Lee, Jong Wook; Ko, Jang Hyu; Seo, Dong Kook; Choi, Jai Koo; Jang, Young Chul

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(4):415-420.
Published online July 1, 2010.

Treatment of Heterotopic Calcification with Ulceration in Burn Scar.

Sang Gu Kang, Jong Wook Lee, Jang Hyu Ko, Dong Kook Seo, Jai Koo Choi, Young Chul Jang

Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea. jwlpsdoc@yahoo.co.kr

Abstract

PURPOSE
Heterotopic calcification is a pathological event in which deposits of calcium salts build up, usually in the joint area or soft tissues. It can occur under many conditions and in some rare cases may develop in burn scars. In particular, ulcerations in burn scars accompanied by heterotopic calcification are difficult to treat through conservative treatment. This study reports methods for accurate diagnosis and adequate treatment of ulceration in burn scars accompanied by heterotopic calcification. METHODS: Fourteen patients who visited our hospital from March 2008 to January 2010 were subjected to this study. Their sex, age, modes of burn, degree, TBSA(%), ulcerated area, the time of occurrence of the ulcerations in the burn scars were investigated. In addition, radiological examination and biopsy was performed to diagnose heterotopic calcification.
RESULTS
Among the 14 cases, 6 were male and 8 were female. The average age of the patients was 48.2(27-69 yrs). As for the mode of burn, 11 were flame burns and 3 were scalding burns. The average time of occurrence of the ulcerations in the burn scars was 4.5 months. The ulcerated areas were situated in the legs in 12 cases, arms in 1 case, and torso in 1 case. The diagnosis was confirmed through X-ray and biopsy, and skin graft was performed after wide excision.
CONCLUSION
Diagnosis of the ulceration in burn scars accompanied by heterotopic calcification is possible through radiological and pathologic studies. Surgical treatment is the most reliable method of treatment, and we chose to perform skin graft after wide excision. Also, we learned that the complete removal of the calcified tissue and the inflammatory fibrotic tissues is crucial in preventing recurrence. Also, in contrast to Marjolin's ulcer, heterotopic calcification had a small size, little or no granulation tissue, and lacked fungating type ulceration. Therefore, favorable prognosis could be achieved through adequate treatment.

Keywords: Hetertopic calcification; Burn scar; Wide excision; Skin graft

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