This patient had a gout attack and Dr. Brennan is gonna make an incision to open up the toe to relieve the pressure from the gouty tophi. Gouty tophi is actually… they're actually crystals from the gout that form in the toe. So, we're gonna try to get some of those out of there to make the toe actually less fat and to relieve the pressure off of the joint. So, right now, he's putting the hemostat in the toe and searching for the tissue, the gouty tissue. The gouty tophi is actually white in color. Sometimes, in an acute attack, it will just ooze out of the foot, but if it's been there for a while, it can actually harden up, almost looking like bone. Right now, we're squeezing the toe to see if we can get anymore tophi out of there and now, he's pulling some out and you can see the white material that's coming out of the toe and that's actually the tophi. And it here comes now. And you can see the white _____. Please show them the white Dr. Brennan.
You see all that white? That's all gouty tissue. It's not supposed to be white like that. It almost looks like sugar on top of the joint. And there's more tophi right there and if you can show us the pieces.

Is this okay?

Yeah.

Okay.

There's more right there. Anything white should not be there. And there's more. Right there, you can see, show us some _____. Can you see that? That's all gouty tophi and gout crystals, but the patient will have a great deal of relief after this, because this would be the last pressure on the joint. And when you put his shoe on, it won't be rubbing against the shoe anymore, so there'll be less pain from the pressure of his shoe. There's more tophi coming out. There's a great deal here. This patient has had more than 1 gout attack in the past that makes the toe even larger. When you look at the toe next to it, you can see how enlarged that second toe is and that's also from previous gout attacks too. That can also be removed surgically by taking some of the bone out and then removing the tissue around the joint as well. And when this is finished, this will be flushed with Betadine and a dressing will be put on after a couple of sutures are put through the toe.

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