Wounds & Ulcers

Wounds & Ulcers

Dr. Ranjeet PatilDefinitionWoundBreach in the continuity of skin or mucous membraneUlcerPersistent breach in the continuity of skin or mucous membrane associated with cell deathAnatomy

Classification WoundsSimpleSkinComplexDeeper

Classification WoundsRank & WakefieldTidySurgical incisionsUntidyCrushing, tearing

Classification WoundsOpenIncisedAbrasionLaceratedCrushPenetratingClosedContusionHematoma

Classification WoundsSurgical WoundsCleanClean ContaminatedContaminatedDirtyManagement of WoundsResuscitation of patientCleaning, DressingHemostasisSplintFluidsInj TT

Management of WoundsIncisedPrimary SuturingLaceratedExcision & Primary SuturingCrushedDebridement, excisionDelayed Primary SuturingDeep devitalisedDebridementSecondary Suturing/ Grafting

Compartment SyndromeCalf, ForearmClosed injury>Hematoma>Increased Pressure/FractureCompression of vesselsPallor, Paraesthesia, Pulselesness, Pain, Swelling, ColdnessRx-Fasciotomy

Crush SyndromeCrushing of Muscles>Extravasation of blood>Myoglobin releaseEarthquakes, Industrial accidents, Air crashesRenal failure, Toxemia, Septicemia, Gas gangreneRx- Multiple deep incisions, Mannitol, NaHCO3, HemodialysisDegloving injuryShearing force between tissue planes as traction-avulsionOne or multiple planesMachine, RTAsDebridement, Excisions, Dressing, Grafts, Flaps

Classification UlcersClinicalSpreadingHealingCallousClassification UlcersPathologicalSpecificMalignantNon-Specific

Specific UlcersTuberculosisSyphilisActinomycosisMeleneys

Malignant UlcersCarcinomatousRodentMelanoticNon-Specific UlcersTraumaticArterialVenousTrophicInfectiveTropicalCryopathicMartorellsBazinsDiabeticCortisolMiscellaneousWagners ClassificationGrade 0- Preulcerative/HealedGrade 1- SuperficialGrade 2- Deeper to subcutaneousGrade 3- Abscess formationGrade 4- Gangrene of part of tissueGrade 5- Gangrene of entire limb

Parts of UlcerMarginEdgeFloorBase

Edge

EdgeMarginRegularIrregularRounded, OvalFloorGranulationRedPale & SmoothWash-LeatherPink, Punctate, Pulseful, Painless, Pin headExuberent

DischargeSerousPurulentSero-purulentBloodySero-sanguinousSulpher granulesBaseOn which the ulcer restsPalpatedIndurated in malignancyTraumatic UlcersAnywhere on bodyLimbs-Shin, Malleoli, JointsChronic- StaphEgPlaster Sores, Dental Ulcers, Footballers Ulcer, Skin burns, Caustic ulcers

Arterial UlcersInadequate skin circulationLimbs- Repeated pressure/traumaCauseesAtherosclerosis- Ant & lat legs, Dorsum, HeelsBuergers disease- Painf, Claudication, Punched out ulcersRaynauds disease

Venous UlcersCommonest on legMedial lower 3rd legPigmentation, Oedema CausesVaricose veins-Perforator incompetence, StasisDVT-Valveless Recanalisation

Trophic UlcersNeurologic deficit, Impaired blood supply & nutritionSitesSacrum, Heel, Buttocks, OcciputBedsores, Perforating UlcersCausesDiabetic Neuropathy, Paraplegia, Leprosy, Spinal injury, Peripheral injury, Peripheral neuritis

Tropical UlcersTropical CountriesCause unknownCallous ulcerDiabetic UlcerDiabetic Neuropathy-Trophic Atherosclerosis-ArterialGlucose laden tissues-Infective

TuberculousBursting of Caseous LNSlightly painfulNeck, Axilla, GroinUndermined thin reddish-blue edge, Sero-sanguinous discharge & indurationEnlarged LNLupus Vulgaris- Cutaneous TB- Face & HandsSyphiliticTreponema PallidumHard Chancre- Ext GenitalsPainless, indurated base(button Like)Nipple, lip, tongue, anal canalSecondary- Mucus patches, CondylomasTertiary Gummatous (Subcut bones)

MalignantMarjolins ulcerSCC from chronic scarMalignantLips, cheeks, penis, vulva, mouth, oesophagus40 yrs+SCC, BCC, Melanoma

OthersSoft Chancre- DucreysPainful, Ext genitals, with BuboMeleneys UlcerPost-op- Perforated viscus, Empyema ThoracisStrepto & Staph, AbdomenMartorell Hypertensive, Old agePost calfBazinsWomenHistoryMode of onsetDurationPainDischargeTreatment takenExaminationInspectionSize & ShapeNumberPositionEdge, Margin, FloorDischargeSurrounding area

PalpationTendernessEdge & marginBaseDepthBleedingSurrounding skin

ExaminationLymph NodesPeripheral pulsationsNervesJoints for mobiltySystemic examinationInvestigationsRoutineSpecificStudy of dischargeEdge biopsyX-ray of partFNAC of LNCXRColour DopplerTreatmentTreatment of causeCorrection of DeficienciesBlood transfusionsPain MangementDebridement, Cleaning, DressingAntibioticsSuturing, Grafts, Flaps

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