The other night, I was lying in bed looking through the “Guidelines for the Treatment of Hyperuricemia and Gout” and I got a lecture from my daughter-in-law. She said, “You’re a surgeon, what kind of medical treatment are you reading?” When I thought about it, she had a point! I am a surgeon to see the treatment of internal diseases, not eaten up, nothing to do idle! But on second thought, that’s not entirely true. Why do you say so? Firstly, I am a gout patient myself, my blood uric acid has been maintained at more than 500, I can read and understand the book, first for their own treatment, and later there is an opportunity to tell others; Secondly, if hyperuricemia urate crystals are deposited near the joints to form gout stones, and cause gouty arthritis, then this belongs to the surgical disease. So take a look at the gout treatment guidelines and you’ll be fine! With the change in diet and the increasing life expectancy of human beings, gout has become the second most common metabolic disease after diabetes. Blood uric acid is the most important factor in determining the development of gout. 10-20 of patients with hyperuricemia％ will develop gout. This means that the relationship between hyperuricemia and gout is a full-set and subset relationship. The prevalence of gout is closely related to blood uric acid levels. When blood uric acid is ≥360umol/L, the risk of developing gout is significantly higher. As an important adjunct, X-rays can reflect the patient’s gout condition to some extent. However, unfortunately, gout may not show any X-ray abnormalities for 5-10 years after the onset of gout. In the early stage, it only shows swelling of the soft tissues of the joints, as shown in the X-ray of the patient I operated on today (significant soft tissue swelling, no bone destruction). Acute gouty arthritis may show a “cloudy sign” on the X-ray, while chronic gouty arthritis may show a “hanging edge sign” of bone destruction! So, let’s talk about the most important aspect: the treatment of gouty arthritis. I remember when I first joined the workforce, I admitted a male patient with a gouty stone in the first metatarsophalangeal joint. After the incision, white bean curd-like urate crystals came out of the wound, and the debridement was very thorough, but the wound never healed after surgery. So why is this? In short, it is still the microenvironment of high uric acid urate crystals that causes the wound not to grow. So, now when it comes to gouty arthritis, I’m really a little bit scared to talk about it! Well, let’s take a look at what the book says: “Gouty arthritis can be treated with early focal debridement, and if it causes pathological fractures, internal fracture fixation should be performed at the same time. For cases with mild cartilage invasion, joint debridement is feasible to remove precipitated uric acid crystals and damaged articular cartilage, and for those with severe deformity of joint destruction, arthroplasty or fusion is feasible!” There is no mention of how that skin is closed during surgery, and what treatment is needed once the wound does not heal! As you can see, non-healing wounds in gouty arthritis are a “big problem”! Let’s look at my patient today. In order to close the non-healing wound, I had to use VSD (vacuum sealing drainage), a negative pressure vacuum suction device to cover the wound, which allows the wound to gradually get smaller and smaller, and then wait for the second stage of flap implantation. In this patient, although the wound eventually heals, the patient will need to be treated medically to prevent this problem from occurring again. In short, gouty arthritis is a big problem, a big problem! For its treatment, medicine and surgery should have a complementary relationship. It’s like two paddles in a boat, if you paddle alone, the boat won’t go far, but only if you work together, the boat can row fast and far!