ulcer presentation

7/28/2019 Ulcer Presentation

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Hugh Cross BSc (pod) PhD - American Leprosy Missions


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Normal Tissue Repair

The active phase

The rapid multiplication phase (proliferative)

The maturation or remodelling phase



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The Active Phase

Damaged tissues release lytic enzymes

Migration of leucocytes and monocytes

Release of transudate into wound cavity



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Features of UlcerationDuring the Active Phase

Undermined Edges

Copious Exudate

Mobile relationshipwith surroundingtissues



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The Rapid Multiplication Phase(Proliferative)

Production of granulation tissue

Migration epithelium

Proliferation of macrophages and fibroblasts



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Features of Ulceration Duringthe Proliferative Phase

Stable granulation

Moderate transudatedischarge

Shelving of ulcer

walls



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The Maturation or RemodellingPhase (Proliferative)

Production of granulation tissue

Migration epithelium

Proliferation of macrophages and fibroblasts



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Features of Ulceration Duringthe Maturation Phase

No swelling

Minimal discharge

Delicate epithelium



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Compromised Tissue Repair

Complicated Ulceration

Vascular Insufficiency

Chronic Ulceration



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Features of Complicated Ulceration

Copious foul smelling

exudateHypergranulation

Inflammation

Sinus tracking



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Presentation of Complicated Ulceration



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Consequences of NeglectedComplicated Ulceration

Septicaemia

Radical bone lossand deformity

Squamous cell

carcinoma



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Features of Chronic Ulceration

Minimal exudate

Fibrous tissue base

Indurated edges

Tied to surrounding tissue



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Presentation of Chronic Ulceration



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Optimising Normal Tissue Repair

The Active Phase

Absorbent Dressings

REST

Debridement of devitalised tissue

Hygiene

Good Nutrition



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Optimising Normal Tissue Repair

The Proliferative Phase

REST

Moist Dressing

The Maturation Phase

Wound Cover

Protected Weight bearing

Moist Dressing



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Factors That CompromiseTissue Repair

Infection

Inappropriate dressings and medications

Unremitting Tissue stress

Vascular insufficiency

Steroidal or neoplastic drugs



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The Assessment of Ulceration

Ulcer Area The greatest distancebetween 2 points onthe edge,longitudinally.

The greatest distancebetween 2 points onthe edge, horizontally.

The area of ulceration

is then calculatedusing the formula:

A = 1.5cm

B = 3.5cm

A = Longitudinal lengthB = Horizontal Length

(1.5 + 3.5 ) x .785 = 4cm 2 Ulcer Area = 4cm 2

(Horizontal length + Longitudinal length) x .785



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The Assessment of Ulceration Edges Floor Discharge

Active Undermined Irregular

Little or no

granulation

Much exudate

Chronic Punched out Granulation

Fibrous tissue

Slight exudate

Hard eschar

Complicated Mixed signs:

Inflammation

Undermined

hypergranulation

Perforating to deep

structures

Sinuses

Much exudate

with pus when

wound is infected

Malignant Curling Pushed out above

skin level

Variable flow of

transudate(sometimes dry)

Healing Sloping with

epithelium

Granulation Slight transudate


Wound Type


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DeepExudes pusFoul smellingArea around wound is hot, red and swollenLymph nodes are tender and swollen

CleanClear dischargeSuperficial

Wound has not improved or has deteriorated

Give assuranceRestElevationWound covering with clean clothClean daily with clean water and

cover again with clean cloth

Wound surface areais smallerLess dischargeNew skin is growing

around the edges Patient hasfollowedinstructionsfaithfully

Congratulate patient andencourage them to continueuntil wound heals completely

Discuss Problems with Patient

Patient has notbeen able tofollowinstructions

Investigate reasons and try and solve problems with the patient.If the wound is not infected encourage home care again.If the wound is infected refer to doctor but remember to follow upwith further problem solving after medical care.

Refer to Doctor

12 Days Later

Surgical DebridementAmputation

Surgical DebridementAntibioticsPlaster of Paris

Unna Boot

Wound Type

ulcer presentation

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