Ulcer Presentation
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Transcript of Ulcer Presentation
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7/28/2019 Ulcer Presentation
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Hugh Cross BSc (pod) PhD - American Leprosy Missions
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Normal Tissue Repair
The active phase
The rapid multiplication phase (proliferative)
The maturation or remodelling phase
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The Active Phase
Damaged tissues release lytic enzymes
Migration of leucocytes and monocytes
Release of transudate into wound cavity
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Features of UlcerationDuring the Active Phase
Undermined Edges
Copious Exudate
Mobile relationshipwith surroundingtissues
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The Rapid Multiplication Phase(Proliferative)
Production of granulation tissue
Migration epithelium
Proliferation of macrophages and fibroblasts
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Features of Ulceration Duringthe Proliferative Phase
Stable granulation
Moderate transudatedischarge
Shelving of ulcer
walls
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The Maturation or RemodellingPhase (Proliferative)
Production of granulation tissue
Migration epithelium
Proliferation of macrophages and fibroblasts
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Features of Ulceration Duringthe Maturation Phase
No swelling
Minimal discharge
Delicate epithelium
Hugh Cross BSc (pod) PhD - American Leprosy Missions
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Compromised Tissue Repair
Complicated Ulceration
Vascular Insufficiency
Chronic Ulceration
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Features of Complicated Ulceration
Copious foul smelling
exudateHypergranulation
Inflammation
Sinus tracking
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Presentation of Complicated Ulceration
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Consequences of NeglectedComplicated Ulceration
Septicaemia
Radical bone lossand deformity
Squamous cell
carcinoma
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Features of Chronic Ulceration
Minimal exudate
Fibrous tissue base
Indurated edges
Tied to surrounding tissue
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Presentation of Chronic Ulceration
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Optimising Normal Tissue Repair
The Active Phase
Absorbent Dressings
REST
Debridement of devitalised tissue
Hygiene
Good Nutrition
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Optimising Normal Tissue Repair
The Proliferative Phase
REST
Moist Dressing
The Maturation Phase
Wound Cover
Protected Weight bearing
Moist Dressing
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Factors That CompromiseTissue Repair
Infection
Inappropriate dressings and medications
Unremitting Tissue stress
Vascular insufficiency
Steroidal or neoplastic drugs
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The Assessment of Ulceration
Ulcer Area The greatest distancebetween 2 points onthe edge,longitudinally.
The greatest distancebetween 2 points onthe edge, horizontally.
The area of ulceration
is then calculatedusing the formula:
A = 1.5cm
B = 3.5cm
A = Longitudinal lengthB = Horizontal Length
(1.5 + 3.5 ) x .785 = 4cm 2 Ulcer Area = 4cm 2
(Horizontal length + Longitudinal length) x .785
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The Assessment of Ulceration Edges Floor Discharge
Active Undermined Irregular
Little or no
granulation
Much exudate
Chronic Punched out Granulation
Fibrous tissue
Slight exudate
Hard eschar
Complicated Mixed signs:
Inflammation
Undermined
hypergranulation
Perforating to deep
structures
Sinuses
Much exudate
with pus when
wound is infected
Malignant Curling Pushed out above
skin level
Variable flow of
transudate(sometimes dry)
Healing Sloping with
epithelium
Granulation Slight transudate
Hugh Cross BSc (pod) PhD - American Leprosy Missions
Wound Type
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DeepExudes pusFoul smellingArea around wound is hot, red and swollenLymph nodes are tender and swollen
CleanClear dischargeSuperficial
Wound has not improved or has deteriorated
Give assuranceRestElevationWound covering with clean clothClean daily with clean water and
cover again with clean cloth
Wound surface areais smallerLess dischargeNew skin is growing
around the edges Patient hasfollowedinstructionsfaithfully
Congratulate patient andencourage them to continueuntil wound heals completely
Discuss Problems with Patient
Patient has notbeen able tofollowinstructions
Investigate reasons and try and solve problems with the patient.If the wound is not infected encourage home care again.If the wound is infected refer to doctor but remember to follow upwith further problem solving after medical care.
Refer to Doctor
12 Days Later
Surgical DebridementAmputation
Surgical DebridementAntibioticsPlaster of Paris
Unna Boot
Wound Type