Post on 15-Nov-2015
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Wounds & Ulcers
Wounds & Ulcers
Dr. Ranjeet PatilDefinitionWoundBreach in the continuity of skin or mucous membraneUlcerPersistent breach in the continuity of skin or mucous membrane associated with cell deathAnatomy
Classification WoundsSimpleSkinComplexDeeper
Classification WoundsRank & WakefieldTidySurgical incisionsUntidyCrushing, tearing
Classification WoundsOpenIncisedAbrasionLaceratedCrushPenetratingClosedContusionHematoma
Classification WoundsSurgical WoundsCleanClean ContaminatedContaminatedDirtyManagement of WoundsResuscitation of patientCleaning, DressingHemostasisSplintFluidsInj TT
Management of WoundsIncisedPrimary SuturingLaceratedExcision & Primary SuturingCrushedDebridement, excisionDelayed Primary SuturingDeep devitalisedDebridementSecondary Suturing/ Grafting
Compartment SyndromeCalf, ForearmClosed injury>Hematoma>Increased Pressure/FractureCompression of vesselsPallor, Paraesthesia, Pulselesness, Pain, Swelling, ColdnessRx-Fasciotomy
Crush SyndromeCrushing of Muscles>Extravasation of blood>Myoglobin releaseEarthquakes, Industrial accidents, Air crashesRenal failure, Toxemia, Septicemia, Gas gangreneRx- Multiple deep incisions, Mannitol, NaHCO3, HemodialysisDegloving injuryShearing force between tissue planes as traction-avulsionOne or multiple planesMachine, RTAsDebridement, Excisions, Dressing, Grafts, Flaps
Classification UlcersClinicalSpreadingHealingCallousClassification UlcersPathologicalSpecificMalignantNon-Specific
Specific UlcersTuberculosisSyphilisActinomycosisMeleneys
Malignant UlcersCarcinomatousRodentMelanoticNon-Specific UlcersTraumaticArterialVenousTrophicInfectiveTropicalCryopathicMartorellsBazinsDiabeticCortisolMiscellaneousWagners ClassificationGrade 0- Preulcerative/HealedGrade 1- SuperficialGrade 2- Deeper to subcutaneousGrade 3- Abscess formationGrade 4- Gangrene of part of tissueGrade 5- Gangrene of entire limb
Parts of UlcerMarginEdgeFloorBase
Edge
EdgeMarginRegularIrregularRounded, OvalFloorGranulationRedPale & SmoothWash-LeatherPink, Punctate, Pulseful, Painless, Pin headExuberent
DischargeSerousPurulentSero-purulentBloodySero-sanguinousSulpher granulesBaseOn which the ulcer restsPalpatedIndurated in malignancyTraumatic UlcersAnywhere on bodyLimbs-Shin, Malleoli, JointsChronic- StaphEgPlaster Sores, Dental Ulcers, Footballers Ulcer, Skin burns, Caustic ulcers
Arterial UlcersInadequate skin circulationLimbs- Repeated pressure/traumaCauseesAtherosclerosis- Ant & lat legs, Dorsum, HeelsBuergers disease- Painf, Claudication, Punched out ulcersRaynauds disease
Venous UlcersCommonest on legMedial lower 3rd legPigmentation, Oedema CausesVaricose veins-Perforator incompetence, StasisDVT-Valveless Recanalisation
Trophic UlcersNeurologic deficit, Impaired blood supply & nutritionSitesSacrum, Heel, Buttocks, OcciputBedsores, Perforating UlcersCausesDiabetic Neuropathy, Paraplegia, Leprosy, Spinal injury, Peripheral injury, Peripheral neuritis
Tropical UlcersTropical CountriesCause unknownCallous ulcerDiabetic UlcerDiabetic Neuropathy-Trophic Atherosclerosis-ArterialGlucose laden tissues-Infective
TuberculousBursting of Caseous LNSlightly painfulNeck, Axilla, GroinUndermined thin reddish-blue edge, Sero-sanguinous discharge & indurationEnlarged LNLupus Vulgaris- Cutaneous TB- Face & HandsSyphiliticTreponema PallidumHard Chancre- Ext GenitalsPainless, indurated base(button Like)Nipple, lip, tongue, anal canalSecondary- Mucus patches, CondylomasTertiary Gummatous (Subcut bones)
MalignantMarjolins ulcerSCC from chronic scarMalignantLips, cheeks, penis, vulva, mouth, oesophagus40 yrs+SCC, BCC, Melanoma
OthersSoft Chancre- DucreysPainful, Ext genitals, with BuboMeleneys UlcerPost-op- Perforated viscus, Empyema ThoracisStrepto & Staph, AbdomenMartorell Hypertensive, Old agePost calfBazinsWomenHistoryMode of onsetDurationPainDischargeTreatment takenExaminationInspectionSize & ShapeNumberPositionEdge, Margin, FloorDischargeSurrounding area
PalpationTendernessEdge & marginBaseDepthBleedingSurrounding skin
ExaminationLymph NodesPeripheral pulsationsNervesJoints for mobiltySystemic examinationInvestigationsRoutineSpecificStudy of dischargeEdge biopsyX-ray of partFNAC of LNCXRColour DopplerTreatmentTreatment of causeCorrection of DeficienciesBlood transfusionsPain MangementDebridement, Cleaning, DressingAntibioticsSuturing, Grafts, Flaps
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