Wounds, ulcers, fistulae & cysts. wounds. Mechanism of injury Traumatic wounds Sharp, penetrating Blunt Bullet Surgical wounds. Types of wounds. Cut wounds incised Lacerated wounds Crushed wounds Wounds with skin loss. Types of Suturing. Primary suturing
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2- Connective tissue formation (granulation tissue)
General: Malnutrition, ureamia, malignancy, radiothempy, cytotoxic drugs, duabetes, vitc deficiency.
- Blood supply
- Tension in wound
- presence of necrotic tissue and F.B
- presence of haematoma
- excessive cauterization, rough manipulation
Correct all local and systemic factors that might impair wound healing
Antibiotics if infected
Ulcers are non-healing wounds that develop on the skin, mucous membranes or eye. Although they have many causes, they are marked by:
4. Peptic ulcer: This includes ulcers of the esophagus, stomach, large and small intestine
Bacterial , viral & fungal infection
Cancer both primary & secondary
Loss of mobility
Surrounding tissue & lymphatics
Pressure ulcer (decubitus)
Arterial insufficiency ulcer
Venous insufficiency ulcer
Diabetic foot ulcer
By definition caused by inadequate blood supply “large \ small artery obliteration”
In elderly , who also have symptoms of coronary vascular disease.
Risk factor – Smoking, atherosclerosis
Very painful, causes rest pain
Do not bleed but discharge thin serous exudates which can become purulent
Distal pulses are impalpable
Deep penetrating ulcer which occur over pressure point, but the surrounding tissue are healthy and have good circulation.
2- surrounding tissues are unable to appreciate pain
3- surrounding tissues have normal blood supply
Follow many year of venous disease.
Commonly occur on the medial side of the leg above the ankle
Predominantly in women
Risk factor – Varicose veins
Pulses are normal
Fistulas is an abnormal communication between two epithelial or endothelial surfaces
Some are congenital e.g. Tracheooesophageal fistula
Internal abdominal fistulas :Majority result from an underlying gastro-
intestinal disease ( e.g. colonic diverticular disease, crohn’s disease, colonic carcinoma, etc )
External abdominal fistulas arise as a complication of surgery or to the trauma.
Other external fistulas are due to primary abscess formation and rupture on to skin. E.g. perianal fistula
Difficult to treat
Is complex and usually surgical
Depend on the site of the fistula
The mainstays of medical management are:
- nutritional support
- meticulous collection of fistulous discharge
- skin-stoma care
- control of sepsis
The absolute indications for operative intervention are :
- intestinal distal obstruction
- abscess formation
- bowel discontinuity
- presence of malignant disease
- persistent inflammatory bowel disease
a cyst is : any closed epithelium-lined cavity or sac, normal or abnormal, usually containing liquid or semisolid material" (Dorland\'s, 1995, pp.209).
It is common can occur anywhere any age.
Cysts vary in size
Its wall called the cyst capsule
Cysts are usually formed through one of these mechanisms:
Obstructions to the flow of fluid
Infections and chronic inflammations
Genetic (inherited) conditions
Defects in developing organs in the embryo
Usually surgical - Cystectomy