This document discusses different types of wounds and ulcers, including their causes and treatments. It provides details on: - Incised wounds which are caused by sharp objects and can often be closed within 6 hours. Deep penetrating wounds may involve deeper tissues. - Lacerated wounds have ragged edges and are commonly infected within 6 hours due to debris. Dead tissue must be removed within 6 hours. - Crush injuries are difficult to manage due to necrosis and tissue tension. Excision and fasciotomy are often needed to relieve tension. - Pressure ulcers are caused by excess pressure and typically occur over bony areas. Prevention is key through frequent repositioning and special mattresses. -

1. WOUNDS and ULCERS
Dr. Milkah O. Angachi
1/2/2023

2. Wounds
• It is a loss of continuity of the skin and
epithelial tissue
• It may be due to several causes thus give rise
to the types of wounds

3. Incised wounds
• Caused
• Sharp objects eg knife razor, glass cut.
• The wounds are relatively clean and may be
closed and may be closed within 6 hours by
primary suture
• You may repair tendons, nerves and blood
vessels at this stage

4. Deep penetrating wounds
• Explore them layer by layer because the injury
may involve beyond what one can see
• Perform laparatomy even in the absence of
peritonitis or peritonism

5. Lacerated wounds
• Wounds with ragged edges
• Common in RTA
• The wound is dirty contaminated and commonly
becomes infected within 6 hours
• There is a lot of dead tissues
Treatment
• Remove dead tissue within the 1st 6 hours
• Drain and irrigate prior to the closure of wound so as
minimise chance of infection that is perform surgical
toilet

6. Crashed devatilised wounds
• Common in industrial or severe RTA, war wounds.
• Difficulties in management
• There’s a lot of dead tissues and cannot differentiate between dead and
live tissue.
• Patient have inflammatory oedema
• Tissue tension which tends to increase with closure of the wound
commonly result into gangrene
• Skin is heavily contaminated with bacteria
• Management
• Excise all necrotic
• To relieve tension by fasciotomy
• To irrigate with normal saline , eusol or hydrogen peroxide and leave it
open then dress it
• Examine the wound within 4-6 days to assess the viability of the tissues
and also check if the tissue tension is resuming to allow secondary suture.

7. Wounds with skin loss
• Skin is the barrier fro infection and healing of the underlying structures
takes place when the skin is intact
• The longer the wound will be exposed the more the scaring and the more
the deformity and disability
• MNX
• Surgical toilet then
• Skin grafting immediately after injury
• Choice of treatment depends on the type of wounds

8. Management
• Identify the organism
• Penicillin used in early stages will abort development of
carbuncles
• Staphylococcal infections is contagious, care especially on
hygiene.
• Avoid plucking, shaving, waxing while infection is active
and for several more weeks.
• Frequent hand-washing and use antiseptics for bathing
• Hot wash clothing, bedding, towels and avoid sharing
clothing
• Oral antibiotics -flucloxcyclin or doxycycline for extensive
or recurrent infections
• Refer to a specialist if a course of several weeks does not
improve
• Additional treatment with rifampicin and clindamycin.

9. Complications
• Cellulitis especially in debilitating
subjects
• Infection of the lymph nodes draining the
affected area
• Secondary boil due to infection of
neighbouring hair follicle
• Stye is due to infection of an eyelash
follicle

10. SKIN ULCERS
• An ulcer is an open wound on the skin.
• It is a discontinuity of epithelial surface due to progressive
destruction cell by cell.
• It could be caused by a health problem such as infection,
by a pressure sore, or by vein problems (venous skin
ulcers). Treatments will depend on the cause of the ulcer.
• There are many different types of ulcers of the skin.
• The two most common types include
– Pressure ulcers/ decubitus ulcers/ bed sore are chronic
wounds caused by excess pressure on the skin on any part
of the body.
– Affects patients whose mobility is impaired
– Typically occurs over the bonny prominences such as the
sacrum. Ischium, elbow, posterior skull, etc.

11. Management
• Dressing is appropriate
• Localised surgical procedure- debridement
and cover by a thick flap of muscle
• Prevention is better than cure- frequent
turning of the patient routine nursing practice
• Train paraplegic relieve pressure areas by
movements at frequent interval
• Use pressure dispersing cushions
• Special matresses

12. Venous skin ulcers
– Venous skin ulcers affect the feet and the legs and
are caused by a reduction of blood flow and
therefore swell.
– The cause may be arterial or other underlying
medical conditions
– It may be due to superficial venous insufficiency
e.g. varicose ulcer and they respond well to
surgical treatment of their varicose veins.
•
• Both conditions can cause similar symptoms of itchy,
painful reddened or blistered skin and open crater-
like sores.
• Due to the difference in the underlying cause,
treatments may vary.

13. Treatment may include
• Superficial venous insufficiency ulcers heal with intensive medical treatment
• Deep venous insufficiency Rx debridement of the skin ulcer, keep it clean.
Apply adequate compression (elastic stocking or with multilayer bandage
technique)
• Skin ulcer wound care
• Daily gentle cleansing of the ulcer
• Whirlpool baths for skin ulcers
• Protective bandages for skin ulcers
• Protective splints for skin ulcers
• Protective pads for skin ulcers
• Topical antibiotics for skin ulcers
• Debridement of skin ulcer
• Removal of dead tissue from the ulcer
• Surgery for skin ulcers
Oral antibiotics for skin ulcers
• Selection can be guided by culturing the skin to identify the organism causing
the infection

14. VARICOSE ULCERS
• Wounds occur due to improper functioning of venous valves, usually of
the legs (hence leg ulcers).
• They are the major occurrence of chronic wounds
• They develop mostly along the medial distal leg, and can be very
painful.
• Edema and fibrinous exudate leads to fibrosis of subcutaneous tissues
with localized pigment loss and dilation of capillary loops
• Arise from venous valves that prevent backflow of blood causing the
pressure in veins to increase
• When venous hypertension exists, arteries no longer have significantly
higher pressure than veins, and blood is not pumped as effectively into
or out of the area
• Venous hypertension may also stretch veins and allow blood proteins
to leak into the extravascular space preventing them from helping to
heal the wound
• Leakage of fibrinogen from veins as well as deficiencies in fibrinolysis
may preventing oxygen and nutrients from reaching cells

15. GANGRENE

16. GANGRENE
• WET GANGRENE
• almost always involves an infection.
• Injury from burns or trauma where a body part is crushed or squeezed can
rapidly cut off blood supply to the affected area, causing tissue death and
increased risk of infection.
• Infection from wet gangrene can spread quickly throughout the body,
making wet gangrene a very serious and potentially life-threatening
condition if not treated quickly.
• GAS GANGRENE
• is rare but dangerous.
• It occurs when infection develops deep inside the body, such as inside
muscles or organs, usually as a result of trauma.
• The bacteria that causes gas gangrene, called clostridia, release dangerous
toxins or poisons that wreak havoc throughout the body, along with gas
which can be trapped within body tissue.
• Immediate medical treatment otherwise death can occur within 48 hours.

17. GANGRENE
Fournier's gangrene
• a rare condition, Fournier's gangrene is caused by an infection in the
genital area. Men are affected more often than women. If the infection
gets into the bloodstream, a condition called sepsis, it can be life-
threatening.
• Symptoms of sepsis may include:
• Low blood pressure
• Rapid heartbeat
• Shortness of breath
• Change in body temperature
• Light-headedness
• Body pain and rash
• Confusion
• Cold, clammy, and pale skin

18. TREATMENT OF GANGRENE
• Removing the dead tissue,
• treating and preventing the spread of
infection,
• Treat the condition that caused gangrene to
develop.
• Surgery. Also called debridement, the dead
tissue is surgically removed to prevent the
spread of infection. In some situations,
amputation (removal of the affected limb,
finger or toe) may be required.

19. • Maggot therapy. Believe it or not, maggots still play a
role in modern medicine. Maggots provide a non-
surgical way to remove dead tissue. When used to
treat gangrene, maggots from fly larvae (specially bred
in a laboratory so they are sterile) are placed on the
wound, where they consume the dead and infected
tissue without harming healthy tissue. They also help
fight infection and speed up healing by releasing
substances that kill bacteria.
• Antibiotics are used to treat and prevent infections.
These are usually given by intravenous injection into a
vein.
• Oxygen therapy. Hyperbaric oxygen therapy may be
used in some cases of wet gangrene or ulcers related
to diabetes or peripheral artery disease

20. • End
• Questions