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    Wounds & Ulcers: Dr. Ranjeet Patil

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    Patrico Rillah Setiawan
    Wounds and ulcers can be classified in several ways. Wounds are breaches in the skin or mucous membrane, while ulcers are persistent wounds associated with cell death. Wounds can be classified as simple or complex, open or closed, and clean, contaminated, dirty or infected. Ulcers can be classified clinically as spreading, healing or callous, and pathologically as specific, malignant or non-specific. Treatment involves cleaning and dressing wounds, debridement of devitalized tissue, antibiotics, and procedures like suturing, skin grafting or flaps to aid healing.

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    Wounds & Ulcers: Dr. Ranjeet Patil

    Uploaded by

    Patrico Rillah Setiawan
    60 views40 pages
    Wounds and ulcers can be classified in several ways. Wounds are breaches in the skin or mucous membrane, while ulcers are persistent wounds associated with cell death. Wounds can be classified as simple or complex, open or closed, and clean, contaminated, dirty or infected. Ulcers can be classified clinically as spreading, healing or callous, and pathologically as specific, malignant or non-specific. Treatment involves cleaning and dressing wounds, debridement of devitalized tissue, antibiotics, and procedures like suturing, skin grafting or flaps to aid healing.

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    Wounds and ulcers can be classified in several ways. Wounds are breaches in the skin or mucous membrane, while ulcers are persistent wounds associated with cell death. Wounds can be classified as simple or complex, open or closed, and clean, contaminated, dirty or infected. Ulcers can be classified clinically as spreading, healing or callous, and pathologically as specific, malignant or non-specific. Treatment involves cleaning and dressing wounds, debridement of devitalized tissue, antibiotics, and procedures like suturing, skin grafting or flaps to aid healing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    60 views40 pages

    Wounds & Ulcers: Dr. Ranjeet Patil

    Uploaded by

    Patrico Rillah Setiawan
    Wounds and ulcers can be classified in several ways. Wounds are breaches in the skin or mucous membrane, while ulcers are persistent wounds associated with cell death. Wounds can be classified as simple or complex, open or closed, and clean, contaminated, dirty or infected. Ulcers can be classified clinically as spreading, healing or callous, and pathologically as specific, malignant or non-specific. Treatment involves cleaning and dressing wounds, debridement of devitalized tissue, antibiotics, and procedures like suturing, skin grafting or flaps to aid healing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 40

    Wounds &

    Ulcers

    Dr. Ranjeet Patil


    Definition
    • Wound
    • Breach in the continuity of
    skin or mucous membrane
    • Ulcer
    • Persistent breach in the
    continuity of skin or mucous
    membrane associated with
    cell death
    Anatomy
    Classification
    Wounds
    •Simple
    •Skin
    •Complex
    •Deeper
    Classification
    Wounds
    • Rank & Wakefield
    • Tidy
    • Surgical incisions
    • Untidy
    • Crushing, tearing
    Classification
    Wounds
    • Open
    • Incised
    • Abrasion
    • Lacerated
    • Crush
    • Penetrating
    • Closed
    • Contusion
    • Hematoma
    Classification
    Wounds
    • Surgical Wounds
    • Clean
    • Clean Contaminated
    • Contaminated
    • Dirty
    Management of
    Wounds
    • Resuscitation of patient
    • Cleaning, Dressing
    • Hemostasis
    • Splint
    • Fluids
    • Inj TT
    Management of Wounds
    • Incised
    • Primary Suturing
    • Lacerated
    • Excision & Primary Suturing
    • Crushed
    • Debridement, excision
    • Delayed Primary Suturing
    • Deep devitalised
    • Debridement
    • Secondary Suturing/ Grafting
    Compartment
    Syndrome
    • Calf, Forearm
    • Closed
    injury>Hematoma>Increased
    Pressure/Fracture
    • Compression of vessels
    • Pallor, Paraesthesia,
    Pulselesness, Pain, Swelling,
    Coldness
    Crush Syndrome
    • Crushing of
    Muscles>Extravasation of
    blood>Myoglobin release
    • Earthquakes, Industrial
    accidents, Air crashes
    • Renal failure, Toxemia,
    Septicemia, Gas gangrene
    • Rx- Multiple deep incisions,
    Mannitol, NaHCO3, Hemodialysis
    Degloving injury
    • Shearing force
    between tissue planes
    as traction-avulsion
    • One or multiple planes
    • Machine, RTAs
    • Debridement,
    Excisions, Dressing,
    Grafts, Flaps
    Classification
    Ulcers
    • Clinical
    • Spreading
    • Healing
    • Callous
    Classification
    Ulcers
    • Pathological
    • Specific
    • Malignant
    • Non-Specific
    Specific Ulcers
    • Tuberculosis
    • Syphilis
    • Actinomycosis
    • Meleney’s
    Malignant Ulcers
    • Carcinomatous
    • Rodent
    • Melanotic
    Non-Specific
    Ulcers
    • Traumatic • Martorells
    • Arterial • Bazin’s
    • Venous • Diabetic
    • Trophic • Cortisol
    • Infective • Miscellaneous
    • Tropical
    • Cryopathic
    Wagner’s
    Classification
    • Grade 0- Preulcerative/Healed
    • Grade 1- Superficial
    • Grade 2- Deeper to
    subcutaneous
    • Grade 3- Abscess formation
    • Grade 4- Gangrene of part of
    tissue
    • Grade 5- Gangrene of entire limb
    Parts of Ulcer
    • Margin
    • Edge
    • Floor
    • Base
    Edge
    Edge
    Margin
    •Regular
    •Irregular
    •Rounded, Oval
    Floor
    • Granulation • Discharge
    • Red • Serous
    • Pale & Smooth • Purulent
    • Wash-Leather • Sero-
    • Pink, Punctate, purulent
    Pulseful,
    Painless, Pin • Bloody
    head • Sero-
    • Exuberent sanguinous
    • Sulpher
    Base
    • On which the ulcer rests
    • Palpated
    • Indurated in malignancy
    Traumatic Ulcers
    • Anywhere on body
    • Limbs-Shin, Malleoli, Joints
    • Chronic- Staph
    • Eg
    • Plaster Sores, Dental Ulcers,
    Footballer’s Ulcer, Skin burns,
    Caustic ulcers
    Arterial Ulcers
    • Inadequate skin circulation
    • Limbs- Repeated
    pressure/trauma
    • Causees
    • Atherosclerosis- Ant & lat legs,
    Dorsum, Heels
    • Buerger’s disease- Painf,
    Claudication, Punched out
    Venous Ulcers
    • Commonest on leg
    • Medial lower 3rd leg
    • Pigmentation, Oedema
    • Causes
    • Varicose veins-Perforator
    incompetence, Stasis
    • DVT-Valveless Recanalisation
    Trophic Ulcers
    • Neurologic deficit, Impaired
    blood supply & nutrition
    • Sites
    • Sacrum, Heel, Buttocks,
    Occiput
    • Bedsores, Perforating Ulcers
    • Causes
    • Diabetic Neuropathy,
    Paraplegia, Leprosy, Spinal
    Tropical Ulcers
    • Tropical Countries
    • Cause unknown
    • Callous ulcer
    Diabetic Ulcer
    • Diabetic Neuropathy-Trophic
    • Atherosclerosis-Arterial
    • Glucose laden tissues-Infective
    Tuberculous
    • Bursting of Caseous LN
    • Slightly painful
    • Neck, Axilla, Groin
    • Undermined thin reddish-blue
    edge,
    • Sero-sanguinous discharge &
    induration
    • Enlarged LN
    Syphilitic
    • Treponema Pallidum
    • Hard Chancre- Ext
    Genitals
    • Painless, indurated
    base(button Like)
    • Nipple, lip, tongue, anal
    canal
    • Secondary- Mucus
    Malignant
    • Marjolin’s ulcer
    • SCC from chronic scar
    • Malignant
    • Lips, cheeks, penis, vulva,
    mouth, oesophagus
    • 40 yrs+
    • SCC, BCC, Melanoma
    Others
    • Soft Chancre- Ducreys
    • Painful, Ext genitals, with Bubo
    • Meleney’s Ulcer
    • Post-op- Perforated viscus, Empyema
    Thoracis
    • Strepto & Staph, Abdomen
    • Martorell
    • Hypertensive, Old age
    • Post calf
    • Bazin’s
    History
    • Mode of onset
    • Duration
    • Pain
    • Discharge
    • Treatment taken
    Examination
    • Inspection • Palpation
    • Size & Shape • Tenderness
    • Number • Edge & margin
    • Position • Base
    • Edge, Margin, • Depth
    Floor
    • Bleeding
    • Discharge
    • Surrounding
    • Surrounding
    area skin
    Examination
    • Lymph Nodes
    • Peripheral pulsations
    • Nerves
    • Joints for mobilty
    • Systemic examination
    Investigations
    • Routine
    • Specific
    • Study of discharge
    • Edge biopsy
    • X-ray of part
    • FNAC of LN
    • CXR
    • Colour Doppler
    Treatment
    • Treatment of cause
    • Correction of Deficiencies
    • Blood transfusions
    • Pain Mangement
    • Debridement, Cleaning, Dressing
    • Antibiotics
    • Suturing, Grafts, Flaps
    Thank you

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