inspection of ulcer for diagnosis in the field of surgery

2. The following points are to be
noted
 Size and shape
 Number
 Position
 Edge
 Floor
 Discharge
 Surrounding area

3. Size and shape
 Size of ulcer is important to know time for required
healing
 To record exact size of an ulcer a sterile gauze may be
pressed on to it to get exact measurements
 Shape of tuberculous ulcer are generally oval
 Syphilitic ulcers are circular or semilunar but may
unite to form serpignous ulcer
 Varicose ulcers are vertically oval in shape
 Carcinomatous ulcers are irregular in both size and
shape

4. Number
 In tuberculous, gummatous, varicose ulcers and soft
chancres more than one ulcer may be present.

5. Position
• It is very important and often gives clue to the
diagnosis.
• Rodent ulcer are usually confined to the upper part of
the face above a line joining the angle of the mouth to
the lobule of the ear, occurring frequently near the
inner canthus of the eye.
• Malignant ulcers are more commonly seen on the lips,
tongue, breast and penis.
• An ulcer on the medial malleolous in a patient with
varicose vein is mostly a varicose ulcer.
• Perforating ulcer or trophic ulcers are more common
on heal of the foot or ball of the foot.

6. Edge
 It is the part of the ulcer between the margin and floor.
 This is an important finding in an ulcer which gives a
clue to diagnosis and also the condition of the ulcer.
 In spreading ulcer the edges are inflamed and
edematous whereas in a healing ulcer the edges, if
traced from the red granulation tissue in the centre
towards periphery, will show blue zone (due to thin
growing epithelium) and a white zone (due to fibrosis
of scar).

7. Types of Edges

8. Types ofEdges
• Undermined edge – it is mostly seen in tuberculosis.
The disease causing the ulcer spreads in an d destroys
the subcutaneous tissue faster than it destroys the
skin. The overhanging skin is thin friable, reddish blue
and unhealthy.
• Punched out edges – it is mostly seen in gummites
ulcer or in a deep trophic ulcer. The edges drop down
at right angle to the skin surface as if it has been cut
out a punch. It is seen in diseases in which activity is
limited to the ulcer itself and does not tend to spread
to the surrounding tissues.

9. • Sloping edge – it is seen mostly in healing traumatic or
venous ulcer. Every healing ulcer has a sloping
egde,which is reddish purple in color and consists of
new healthy epithelium.
• Raised and pearly white beaded edge – it is a feature of
rodent ulcer which develops in invasive cellular
diseases and becomes necrotic at the centre.
• Rolled (everted)edge – it is characteristic feature of
squamous cell carcinoma or an ulcerated adeno-
carcinoma.This ulcer is caused by fast growing cellular
disease, growing portion at the edge of the ulcer heaps
up and spills over the normal skin to produce an
everted edge.

10. Floor
• This is the exposed surface of the ulcer. One must be
very careful to note what is there at the floor of an
ulcer.
• When floor is covered with red granulation tissue, the
ulcer seems to be healthy and healing.
• Pale and smooth granulation tissue indicates a healing
ulcer.
• Wash leather slough on the floor of ulcer is
pathognomonic of gummatous ulcer.
• A black mass at the floor suggests malignant
melanoma.

11. Discharge
• The character of the discharge should be noted, its
amount and smell.
• A healing ulcer will show scanty serous discharge, but
the spreading and inflamed ulcer will show purulent
discharge.
• Serosanguineous discharge is often seen in a
tuberculoses ulcer or a malignant ulcer.

12. Surrounding area
• If the surrounding area of an ulcer is glossy, red and
edematous, the ulcer is acutely inflamed.
• Very often the surrounding skin of varicose ulcer is
eczematous and pigmented.
• A scar or wrinkling in surrounding a skin of an ulcer
may well indicate an old case of tuberculosis.