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Cutaneous Ulcers

The document provides a comprehensive overview of cutaneous ulcers, defining them as breaches in the epithelium of tissues and classifying them based on etiology, anatomy, and duration. It details specific types of ulcers, their phases, and management strategies, including treatment of the underlying causes and wound care techniques. Additionally, it discusses various investigations to determine the etiology of ulcers.

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christomlin
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20 views25 pages

Cutaneous Ulcers

The document provides a comprehensive overview of cutaneous ulcers, defining them as breaches in the epithelium of tissues and classifying them based on etiology, anatomy, and duration. It details specific types of ulcers, their phases, and management strategies, including treatment of the underlying causes and wound care techniques. Additionally, it discusses various investigations to determine the etiology of ulcers.

Uploaded by

christomlin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CUTANEOUS

ULCERS
DR OKORIE GABRIEL
CONSULTANT PLASTIC SURGEON
DEFINITION OF ULCER
ULCER :
• A BREACH OR DISRUPTION IN THE EPITHELIUM OF A
TISSUE OR ORGAN

SKIN : EPIDERMIS = EPITHELIUM

WOUND :
• A DISRUPTION IN THE STRUCTURE ( ANATOMIC) AND
FUNCTION ( PHYSIOLOGIC) OF A TISSUE DUE TO ENERGY
TRANSFER
CLASSIFICATION OF
ULCERS
1. BASED ON AETIOLOGY
• SPECIFIC
• NON - SPECIFIC
• NEOPLASTIC

2. ANATOMIC CLASSIFICATION
• LEG ULCER
• HAND ULCER etc
CLASSIFICATION Cont'd
3. DURATION & TYPE OF INFLAMMATORY
PROCESS

< 3WKS = ACUTE ULCER


• FEATURES OF ACUTE INFLAMMATION
• COLLAGEN ARE LAID IN AN ORGANISED PATTERN

>3 WKS = CHRONIC ULCER


FEATURES OF CHRONIC INFLAMMATION
COLLAGEN MATERIALS ARE LAID IN HAPHAZARD MANNER
SPECIFIC ULCERS
• AETIOLOGY IS KNOWN

• TYPES INCLUDE:

• TROPICAL ULCERS
• TUBERCULOUS [ BURULI ]
• SYPHILITIC
• YAW ULCER
NON SPECIFIC ULCERS
• AETIOLOGY IS UNKNOWN

• POST CELLULITIC ULCER


• ULCERS OF UNKNOWN ORIGIN
• TRAUMATIC ULCER
• ULCERS OF VASCULAR ORIGIN
1. VENOUS [GRAVITATIONAL] ULCERS
2. ARTERIAL ULCER
NON SPECIFIC ULCERS
• NEUROTROPIC [ TROPHIC] ULCERS
• DIABETIC NEUROPATHIC ULCERS
• PERIPHERAL NEUROPATHIES
NEOPLASTIC ULCER
• MARJOLIN'S ULCER

• SQUAMOUS CELL CARCINOMA ( SCC)

• BASAL CELL CARCINOMA ( BCC)

• MELANOMA
EDGE OF ULCER
1. SLOPING : 3. PUNCHED OUT:
• ULCER IN HEALING PHASE ¬ SYPHILITIC
• TROPICAL ULCER

2. UNDERMINED: 4. RAISED OR EVERTED:

• TUBERCULOUS ¬ NEOPLASTIC
EDGE OF ULCER
EDGES OF ULCER

RAISED EVERTED
PHASES OF ULCER
• 4 PHASES
1. ACUTE OR INFECTIVE
2. TRANSITION
3. HEALING
4. CHRONIC OR INDOLENT
ACUTE OR INFECTIVE
PHASE
• SYNONYM = EXPANSION PHASE
• FEATURES:
• FLOOR= CONTAINS SLOUGH
• DISCHARGE = PURULENT
• EDGE = SHARP
• SURROUNDING SKIN = OEDEMATOUS
TRANSITION
PHASE
• FLOOR = DECREASED SLOUGH
• DISCHARGE = DECREASED
• GRANULATION TISSUE = PRESENT BUT UNHEALTHY
• EDGE = SLIGHTLY SLOPING
• SURROUNDING SKIN = HYPERAEMIC OR NORMAL
HEALING PHASE
• SYNONYM: REPARATIVE PHASE
• ULCER = PAINLESS
• GRANULATION TISSUE = HEALTHY
• FLOOR = NO SLOUGH WITH EPITHELIUM
MIGRATING FROM THE EDGES
• SURROUNDING SKIN =NORMAL
CHRONIC PHASE
• SYNONYM : INDOENT OR CALLOUS PHASE
• FEATURES:
• EDGES : JAGGED
• FLOOR: MUCH SLOUGH
• DISCHARGE : PROFUSE & OFFENSIVE
• SURROUNDING SKIN : OEDEMATOUS
VENOUS ULCER
• CAUSES:
1. INCOMPETENT VALVES
• VARICOSE VEIN
• DVT VENOUS STASIS

2. VENOUS HYPERTENSION
LOCATION : ¬ GAITER AREA
ARTERIAL ULCER
• ATHEROSCLEROSIS  ISCHAEMIA  ULCERATION

• LOCATION:
• TOES
• DORSUM OF FOOT
• HEEL
NEUROPATHIC ULCER
• CAUSE:
• SENSORY LOSS ( FROM NEUROLOGICAL DISORDER)

• LOSS OF PAIN PERCEPTION  SUSTAINED PRESSURE


 ULCERATION
• LOCATION:
¬ SOLE OF FOOT
¬ OVER BONY PROMINENCES
TROPICAL ULCER
• OCCURS IN PEOPLE LIVING IN THE TROPICS
• LOCATION:
• LEGS & FEET
• CAUSE:
• SYNERGISTIC ACTION BTW ANAEROBIC
FUSOBACTERIA ( Bacteroides fusiformis) & AEROBE
( Borrelia vincenti)
• PAINFUL SEPTIC BLISTER  ULCER
BURULI ULCER
• SYNONYM: BAIRNSDALE ULCER
• CAUSE : Mycobacterium ulcerans
• STARTS AS CHRONIC INFLAMMATION  ULCER
CRYOPATHIC ULCER
• CAUSE: EXPOSURE TO LOW TEMP
2 TYPES :
1. CHILBLANS ( PERNIOSIS):
• INTENSE VASOCONSTRICTION OF SKIN ARTERIOLES

• TENDER,RED,PRURITIC SWELLING  BLISTER 


ULCER

• LOCATION: FEET AND TOES


CRYOPATHIC ULCER
cont’d
2. FROSTBITE:
CAUSE :
I. EXPOSURE TO WET COLD JUST ABOVE FREEZING
TEMP FOR PROLONGED PERIOD

ARTERIOLAR SPASM
II. STASIS OF BLOOD IN DAMAGED CAPILLARIES 
WORSENING OF ISCHAEMIA
III. DENATURATION OF PROTEINS & ENZYMES 
APOPTOSIS
INVESTIGATIONS
• DEPENDS ON AETIOLOGY
• VENOGRAPHY
• ANKLE-BRACHIAL PRESSURE INDEX ( ABPI)
• ARTERIOGRAPHY
• WOUND SWAB
• ZIEHL NEELSEN STAINING
• PCR
• DOPPLER / DUPLEX SCANNING
• CT /MRI ANGIOGRAPHY
MANAGEMENT OF ULCERS
• TREAT THE AETIOLOGY
•
• TIME MGT OF WOUND
T = TISSUE DEBRIDEMENT
I = INFECTION CONTROL
M = MOISTURE
E = EDGE APPOSITION OR EPITHELIAL MIGRATION

• COMPRESSION....... BANDAGE OR STOCKING


• SKIN COVERAGE

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