Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2023; 11(36): 8568-8573
Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8568
Post-laparotomy heterotopic ossification of the xiphoid process: A case report
Seung Soo Lee
Seung Soo Lee, Department of Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
Seung Soo Lee, Department of Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
Author contributions: Lee SS contributed to conceptualization, design of the study, acquisition and analysis of data, drafting and revising the manuscript, and final approval of the version to be submitted.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seung Soo Lee, MD, PhD, Associate Professor, Surgical Oncologist, Department of Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, South Korea. peterleess@knu.ac.kr
Received: October 16, 2023
Peer-review started: October 16, 2023
First decision: November 21, 2023
Revised: November 24, 2023
Accepted: December 13, 2023
Article in press: December 13, 2023
Published online: December 26, 2023
Processing time: 67 Days and 0 Hours
Abstract
BACKGROUND

Heterotopic ossification (HO) represents all types of extraskeletal ossification in the body. It occurs in various areas, including the skin, subcutaneous tissue, muscle, and joints. Surgical excision is recommended for symptomatic HO. Postoperative radiotherapy, oral nonsteroidal anti-inflammatory drugs, and topical sealants, such as bone wax, have been recommended as preventive measures. As HO is rare in occurrence, these recommendations are based on personal experiences, and there is a lack of information on individualized treatments depending on its location.

CASE SUMMARY

A 62-year-old male was admitted for symptomatic HO along a laparotomy scar. Surgical excision was performed for an 11 cm-sized ossification originating from the xiphoid process, and bone wax was applied to the excisional margin. However, the surgical wound failed to heal. After several weeks of saline-soaked gauze dressing, delayed wound closure was performed. The patient was finally discharged eight weeks after the excision. Because HO can occur in various areas of the body, a treatment strategy that may be effective for some may not be for others. Bone wax has been used as a topical sealant over excisional margins in the shoulder, elbow, and temporomandibular joints. However, in our case, its application on an abdominal surgical wound delayed its primary healing intention. The valuable lesson was that, when choosing a treatment method for HO based on available research data, its location must be considered.

CONCLUSION

Complete excision should be the priority treatment option for symptomatic HO along the laparotomy scar. Bone wax application is not recommended.

Keywords: Heterotopic ossification; Joints; Laparotomy; Waxes; Wound healing; Case report

Core Tip: Heterotopic ossification (HO) represents all types of extraskeletal ossification, and occurs in various areas, including the skin, muscle, and joints. There are some suggested treatment and preventive approaches for symptomatic HO, which include surgical excision and preventive measures such as postoperative radiotherapy, oral nonsteroidal anti-inflammatory drugs, and topical sealants (bone wax). However, these recommendations are based on personal experiences limited to HO in certain locations. It is important to individualize our treatment approaches depending on its location. For symptomatic HO along the laparotomy scar, complete surgical excision should be the priority treatment option, and bone wax application is not recommended.