An ulcer is a break in the skin or mucous membrane. It has a margin, edge, floor, and base. Ulcers can be classified clinically as spreading, healing, or callous based on the edge appearance. They can also be classified pathologically as specific, malignant, or non-specific. Investigations of an ulcer include studying the discharge, biopsy of the edge, and x-ray. Treatment involves finding and treating the cause, debridement, and dressings.

1. ULCER
An ulcer is a break in the continuity of
the covering epithelium either skin or mucous
membrane .
PARTS OF AN ULCER
1 : Margin
2 : Edge
3 : Floor
4 : Base

2. 1 : Margin
It may be regular or irregular . It may be
rounded or oval .
2 : Edge
Edge is one which connects floor of the
ulcer to the margin .
3 : Floor
Floor is a deepened part and may contain
the discharge , granulation tissue , or slough .
4 : Base
Base is the one on which ulcer lies . It may
be bone or soft tissue .

3. DIFFERENT TYPES OF EDGES
A : SLOPING EDGE
It is seen in a healing ulcer its inner
part is red because of healthy granulation
tissue and outer part is white due to scar .
B : UNDRMINED EDGE
It is seen in cases of Tuberculous
ulcer .

4. C : PUNCHED OUT EDGES
It is seen in granulomatous
( syphilitic ) ulcer and bed sores .
D : RAISED AND BEADED EDGES
( Pearly white )
It is seen in rodent ulcer .( BCC ).
E : EVERTED EDGE ( Rolled out edge )
It is seen in carcinomatous ulcer
due to spillage of the proliferating malignant
tissues over the normal skin .

6. CLASSIFICATION OF ULCER ( CLINICAL )
1 : SPREADING ULCER
In this edge is inflamed and
edematous .
2 : HEALING ULCER
sloping edge with healthy , pink and
red tissue .
3 : CALLOUS ULCER
Floor contains pale unhealthy
granulation tissue with indurated edge . This
ulcer is for months and years because of
callous attitude of the patient .

7. CLASSIFICATION OF ULCER
( PATHOLOGICAL)
1 : SPECIFIC ULCER
- Tuberculous ulcer
- Syphilitic ulcer
- Actinomycosis
2 : MALIGNANT ULCER
- Carcinomatous ulcer
- Rodent ulcer
- Melanotic ulcer
3 : NON SPECIFIC ULCER
- Traumatic ulcer
- Arterial ulcer

8. - Venous ulcer or
- Gravitational ulcer
- Trophic ulcer / pressure sore
- Diabetic ulcer

9. WAGNER’S GRADING OF AN ULCER
GRADE : 0
Preulcerative lesion / healed ulcer
GRADE : 1
Superficial ulcer
GRADE : 2
Ulcer deeper to subcutaneous tissue ,
exposing soft tissues or bone .
GRADE : 3
Abscess formation / osteomylitis
GRADE : 4
Gangrene of part of tissue / limb / foot
GRADE : 5
Gangrene of entire one area / foot

10. INVESTIGATIONS OF AN ULCER
1 : STUDY OF A DICHARGE
- Culture and sensitivity
- AFB study and cytology
2 : WDGE BIOPSY
- Biopsy is always taken from
edge because edge contains multiplying cells .
- At least 2 biopsies are taken .
3 : X-RAY OF THE PART to look for
- Periostitis / osteomylitis
4 : FNAC of the lymph node

11. TREATMENT OF AN ULCER
Cause should be found and treated .
Debridement of an ulcer .
All dead , devitalized necrotic tissue is
removed and dressing is applied like :
- Liquid paraffin dressing
- Cotton dressing

12. INTRODUCTION
TO
SURGICAL INFECTIONS

13. SURGICAL INFECTION
Surgical infection is a major surgical
problem in surgical practice and here are the
protective mechanisms like phagocytes ,
antibodies , leucocytes and complement
system . They have an important role in
protecting the infection .

14. SEPSIS
clinical evidence of infection .
SEPSIS SYNDROME
clinical evidence of infection plus evidence
of altered organ perfusion.
SEPTIC SHOCK
Septic syndrome plus evidence of decreased
blood pressure unresponsive to fluid therapy .

15. CLINICAL INDICATORS OF INFECTION
CHANGES IN CORE TEMPERATURE
- Fever > 37. 8 C
- hypothermia < 36 C
Unexlained hypotension
oliguria
confusion

16. POSSIBLE FOCI OF INFECTION
ABDOMINAL EXAMINATION
Bowel
inflammatory bowel dissease ,
perforation , abscess
hepatobiliary
cholecystitis , cholangitis
genitiurinary
uti
RESPIRATORY EXAMINATION
Pneumonia

17. C V S
endocarditis
skin
surgical wound infection
cns
meningitis , enchephalitis

18. SEPTIC SCREENING
BLOOD TEST