Ulcers & wounds

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Ulcers & wounds

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

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