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    Woundcare Management

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    nurhadirah94
    The document discusses ulcer classification, management, and treatment. It defines an ulcer as a break in the skin or mucous membrane epithelium due to cell death or trauma. Ulcers are classified based on etiology and pathology, and can be malignant. Treatment depends on the ulcer type but generally includes identifying and treating the underlying cause, surgical debridement, dressings, skin grafts, flaps, or amputation. Modern dressings like films, hydrogels, and foams aid healing. Vacuum-assisted closure uses negative pressure to promote granulation.

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    Woundcare Management

    Uploaded by

    nurhadirah94
    4 views42 pages
    The document discusses ulcer classification, management, and treatment. It defines an ulcer as a break in the skin or mucous membrane epithelium due to cell death or trauma. Ulcers are classified based on etiology and pathology, and can be malignant. Treatment depends on the ulcer type but generally includes identifying and treating the underlying cause, surgical debridement, dressings, skin grafts, flaps, or amputation. Modern dressings like films, hydrogels, and foams aid healing. Vacuum-assisted closure uses negative pressure to promote granulation.

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    The document discusses ulcer classification, management, and treatment. It defines an ulcer as a break in the skin or mucous membrane epithelium due to cell death or trauma. Ulcers are classified based on etiology and pathology, and can be malignant. Treatment depends on the ulcer type but generally includes identifying and treating the underlying cause, surgical debridement, dressings, skin grafts, flaps, or amputation. Modern dressings like films, hydrogels, and foams aid healing. Vacuum-assisted closure uses negative pressure to promote granulation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    4 views42 pages

    Woundcare Management

    Uploaded by

    nurhadirah94
    The document discusses ulcer classification, management, and treatment. It defines an ulcer as a break in the skin or mucous membrane epithelium due to cell death or trauma. Ulcers are classified based on etiology and pathology, and can be malignant. Treatment depends on the ulcer type but generally includes identifying and treating the underlying cause, surgical debridement, dressings, skin grafts, flaps, or amputation. Modern dressings like films, hydrogels, and foams aid healing. Vacuum-assisted closure uses negative pressure to promote granulation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 42

    Ulcer management

    Ulcer

    • Definition
    • Classification
    • Malignant ulcer
    • Management
    • Dressing
    • Flap and graft
    Definition

    • break in the continuity


    epithelium either skin or
    mucous membrane due to
    molecular death of surface
    epithelium or traumatic
    removal
    Classification
    Etiology Clinical Pathological

    1)Spreading 1)Non specific


    1)Traumatic 2)Healing 2)Specific
    2)Vascular 3)Callous 3)Malignant ulcer
    3)Neoplastic -squamous cell carcinoma
    4)Metabolic -basal cell carcinoma
    5)Infection (rodent ulcer)
    6)Inflammatory -malignant melanoma
    6)Neurogenic
    7)Malnutrition
    Malignant ulcer
    Treatment squamous cell carcinoma

    • Surgical excision
    • Mohs micrographic
    surgery
    • Radiation therapy
    • Chemotherapy
    Clinical picture
    • history
    -duration :acute(<12w),chronic(>12w)
    -mode onset:traumatic,spontaneous(follow swelling/burn)
    -pain:
    *painful:inflammation
    *slight painful:TB
    *painless:syphilis,neurogenic,malignant
    -discharge:
    *purulent:spreading
    *serous:healing
    *blood:malignant
    Local Examination
    1)Inspection
    • site:
    varicose vein-lower limb
    rodent ulcer-face
    tuberculous-cervical
    trophic ulcer-heel
    malignant ulcer-anywhere
    • shape
    oval:TB
    circular:syphilis
    vertical oval:varicose
    irregular:malignant
    • size
    -small,faster heal
    • skin surrounding
    • floor
    -black:melanoma
    -red granulation:healing
    • number
    -TB,syphilis
    • edges
    2)Palpation
    • tenderness
    *tender:inflamed ulcer
    *slight tender:TB,syphilis
    *non tender:malignant,chronic,neurogenic
    • edges
    *hard induration:malignant ulcer
    *firm induration:chronic ulcer,syphilis
    • depth
    *trophic ulcer deep to reach the bone
    • base
    *slight induration:syphilis
    *marked induration:malignant
    • bleeding
    • fixed to deep structure
    3)Examination LN(dep on site of ulcer)
    tender enlarge:secondary infection
    enlarge,firm,matted LN:TB
    enlarge,hard,fixed LN:malignant ulcer
    4)Examination of vascular(dep on site of ulcer)
    -absence/weak pulse
    -trophic changes-shiny skin,thin limb,loss hair,brittle skin
    Laboratory investigation

    -FBC,ESR
    -swab /tissue C+S
    -serum glucose
    -LFT/protein
    -CRP
    -biopsy(wedge/excision)
    Imaging

    • X ray
    -gas shadow in soft tissue
    • US
    • CT scan-evaluate soft
    tissue/bony invasion/LN
    • MRI-evaculate perineural
    invasion/intracranial
    invasion
    Treatment

    1)Conservative
    2)Surgical
    Conservative

    • identify cause and treat


    • correct anemia and deficiency
    • blood transfusion if needed
    • control pain and infection(steroid,antimicrobial agent)
    • Nutritional support
    • Limb elevation
    • Control blood glucose
    • dressing
    Surgical
    • Surgical debridement
    • Skin graft
    • Skin flap
    • Limb amputation
    Dressing
    Type of dressing 2)Modern
    • Film
    1)Conventional
    • Hydrogel
    • non antiseptic(normal
    • Hydrocolloid
    saline,water for irrigation)
    • Calcium alginate
    • Antiseptic(chlorhexidine,su
    peroxidised • Foam(TEHO,duoderm
    solution,polyhexamethylen ,aquacell)
    e biguanide) • Hydrofiber
    • Others(povidone,hydrogen • Charcoal
    peroxide) • Silver
    • polymem dressing
    Vaccuum assisted closure(NPWD)
    • Def:creation of intermittent negative pressure of -125mmHg to promote
    formation of healthy granulation tissue
    • Negative pressure
    -reduce edema
    -clear interstitial fluid
    -improve perfusion
    -increase cell proliferation
    -promote healing
    • Once ulcer granulate well,flap cover or skin graft is done
    Surgical
    • Surgical debridement
    • Skin graft
    • Skin flap
    • Limb amputation
    Reference

    • https://onlinelibrary.wiley.com/doi/full/10.1002/app.47738
    • Wound care manual, Ministry of Health Malaysia
    • https://www.medscape.com/answers/460282-200671/what-are-
    diabetic-foot-ulcers

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