Calciphylaxis and its surgical significance.

Calciphylaxis is a rare but significant condition. It is associated with a high degree of morbidity and is fatal in between 60% and 80% of patients. It occurs most commonly in patients with endstage renal failure and is associated with hypercalcaemia or hyperphosphataemia or both (elevated calcium-phosphate product). Secondary hyperparathyroidism is also common. Clinically, patients develop rapidly progressive, necrotic skin ulcers that are extremely painful. They, universally, respond poorly to usual ulcer therapies. Some surgeons advocate parathyroidectomy for patients with calciphylaxis. Evidence is inconclusive regarding this treatment; however, some trials have shown improved rates of ulcer healing and overall survival in patients treated with parathyroidectomy.