Presentation on theme: "Ulcer Foot By Dr R.N.M. Francis M.S Prof of surgery SBMC."— Presentation transcript:
1Ulcer FootByDr R.N.M. Francis M.SProf of surgerySBMC
2DefenitionA breach in continuity of skin or epithelium, due to molecular death of tissue.Parts of an ulcerMarginEdgeFloorDischargeBase
3Margin of the ulcer denotes the junction between the normal and the ulcerated area. It gives the shape of the ulcer: RoundOvalIrregular
4Floor of the ulcerThe exposed part of the ulcer is called the floorThe floor may be covered by:Red granulation tissue healing ulcerUnhealthy granulation tissueSlough InfectedWash leather syphilisGRANULATION TISSUEProliferation of new capillaries and fibroblasts intermingled with RBC and WBC with thin fibrin cover over it .
5Edge of an ulcerIt is the part of the ulcer between the floor and the margin.It denotes the nature of the ulcer:Sloping healingEverted malignancyUndermined tuberculosisPunched out penetrating
6Base of an ulcerBase is the structure on which the ulcer lies.It is a palpatory finding.Marked induration is a feature of malignancy.
7Discharge in an ulcerSerous healingPurulant infectedBloody neoplasticSerosanguinous infectedGreenish Pseudomonas infected
8Examination of an ulcer General survey:Build of the patientEvidence of any systemic disorder2) Local examination :InspectionPalpation3)Regional examination:a) Examination of lymph nodesb) Examination for vascular insuffiency ---- peripheral pulsesc) Examination for varicose veinsd) Examination for nerve lesion
9Types of ulcersUlcers can be grouped depending uponNature of progressHealing ulcerSpreading or active ulcerCallous ulcerZones in the margin of healing ulcerRed zone : Healing zone and reflects granulation tissue.White zone: Denotes area of fibrous tissue reaction on the skin sideBlue zone: Junction between the two.
10b) Nature of pathologyNonspecific ulcersSpecific ulcersMalignant ulcers
12Caused by specific aetiological factors Specific ulcersCaused by specific aetiological factorsProduces typical features for that aetiologyTypes: TuberculousSyphilisActinomycosisMeleney’s ulcerHemolytic strepococcal gangreneMeleney’s ulcer
14Non specific ulcersIschaemic ulcersDue to poor blood supplyDevelop over limbsOver pressure areasSuperficial, later become deepPainfulCan be multiple
15Venous ulcersComplication of varicose veins and DVTDue to ambulatory venous hypertensionSeen in the lower third of medial aspect of leg because of the presence of direct perforating veins which transmit the pressure changes directly to the superficial system.
16Trophic ulcers (Penetrating ulcers) Seen in: Neurological casesHansen’s diseaseDiabetesCommon sites: HeelBall of footSacrococcygeal regionFeatures:Deep ulcersBase may be formed by underlying bonePunched out edgesFoul smelling sloughSurrounding insensitivity
17Tropical ulcersThese ulcers are sometimes seen in tropical countries.They are also called as Delhi boil, Baghdad sore.They are thought to be due to Vincent’s organism.It starts as an indurated papule on exposed surface.Leads to formation of an indolent ulcer.Leaves back an ugly and pigmented scar.
18Tuberculous ulcerThe edge of the ulcer is undermined.Pale granulation tissue in the floor.Serous discharge.It results secondary to caseous lymph nodes.
19Marjolins ulcerSquamous cell carcinoma developing in a scar tissue or chronic ulcer.Everted edgesIndurated baseBleeding on touchRegional lymph nodes are not involved.Poor response to radiotherapy
20Footballer’s ulcerAlso called as traumatic ulcer.Occurs on shin of tibia.If not treated can become indolent and adherent to bone.Usually acquired during game of football.
21Investigations1) Lab investigatiosUrine routineBlood ureaBlood sugar2) Discharge for culture and sensitivity.3) Staining of the discharge for AFB.4) Wedge biopsy.5) X-ray
22TreatmentConservativeRest to the partAvoid local irritationImprove the nutrition: Protein supplementationVitamin supplementationBlood transfusionAppropriate antibioticsTreat the cause
23Local methods of taking care of the ulcer 1) Separation of sloughHypochlorite solution0.5% silver nitrateNormal saline soaks2) Local coverage of the ulcerAmnionGauze impregnated with antibiotics --- Sofra tulle
24Application of copper sulphate crystals 3) Excessive granulationExcisionCurettageApplication of copper sulphate crystalsSurgical methods that may be employedExcision of the ulcer and graftingCovering the area with SSG
25Requisites for an ideal dressing Should maintain high humidity between wound and the dressing.Remove excess exudates.Permit gaseous exchange.Impermeable to microorganismsAllow easy removalCost effective
26Some of the local wound care modalities Agent Composition Function Commercial namesPolymer films Polyurethane Allows water vapour Opsite, tagadermpermeationHydrocolloids Hydrophilic colloid Impermeable to fluids Intrasiteparticles & bacteriaAlginates Seaweed polymer Absorbs exudates Algisorbnon-adherentMedicated Soframycin Topical antibiotic SofratulleGauze BacitracinRhPDGF Acts through Stimulates angiogenesis PlerminRhEGF tyrosinekinase Stimulates Regen- Dreceptor epithelialisation
27Diabetic ulcerControl the sugarPerform culture/ sensitivityDesloughingAntibioticsLocal amputation/ disarticulation