Wounds, ulcers, fistulae & cysts
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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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Wounds, ulcers, fistulae & cysts

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Wounds ulcers fistulae cysts

Wounds, ulcers, fistulae & cysts


Wounds

wounds


Wounds ulcers fistulae cysts

  • Mechanism of injury

  • Traumatic wounds

  • Sharp, penetrating

  • Blunt

  • Bullet

  • Surgical wounds


Types of wounds

Types of wounds

  • Cut wounds incised

  • Lacerated wounds

  • Crushed wounds

  • Wounds with skin loss


Types of suturing

Types of Suturing

  • Primary suturing

  • Excision and primary suturing

  • Delayed primary suturing

  • Secondary suturing

  • Skin grafting


Elements of wound healing

Elements of Wound Healing

1- Contraction

2- Connective tissue formation (granulation tissue)

3- Epithelization


Surgical wounds

Surgical Wounds

Clean

Clean contaminated

Contaminated

Dirty


Factors which affect wound healing

Factors which affect wound healing

General: Malnutrition, ureamia, malignancy, radiothempy, cytotoxic drugs, duabetes, vitc deficiency.

Local Factors:

- Blood supply

- Tension in wound

- presence of necrotic tissue and F.B

- presence of haematoma

- excessive cauterization, rough manipulation

- infection


Wounds ulcers fistulae cysts

  • Complications of Wounds:

  • Wound infection

  • Wound dehiscence

  • Hyper trophied scar, keloid


Principles of wound management

Principles of wound management

Correct all local and systemic factors that might impair wound healing

Wound toilet

Wound dressing

Antibiotics if infected


Ulcers

Ulcers


Wounds ulcers fistulae cysts

  • Ulcers are non-healing wounds that develop on the skin, mucous membranes or eye. Although they have many causes, they are marked by:

  • Loss of integrity of the area

  • Secondary infection of the site by bacteria, fungus or virus

  • Generalized weakness of the patient

  • Delayed healing


Location

Location

  • Lower limbs: most ulcers of the foot and leg are caused by underlying vascular insufficiency . The skin breaks down or fails to heal because of repeated insult or trauma.

  • Sacrum and ischium

  • Mouth ulcer


Wounds ulcers fistulae cysts

Cont…

4. Peptic ulcer: This includes ulcers of the esophagus, stomach, large and small intestine

  • Genitalia: May be penile, vulvar or labial. Most often are due to sexually-transmitted disease.

  • Eyes: corneal ulcers are the most common type. Conjunctival ulcers also occur.


Causes

causes

Bacterial , viral & fungal infection

Cancer both primary & secondary

Venous stasis

Arterial insufficiency

Diabetes

Rheumatoid arthritis

Loss of mobility


Description

Description

Site

Size

Shape

Base

Edge

Tenderness

Discharge

Surrounding tissue & lymphatics


Types

Types

Peptic ulcer

Mouth ulcer

Pressure ulcer (decubitus)

Arterial insufficiency ulcer

Venous insufficiency ulcer

Diabetic foot ulcer


Ischaemic ulceration

Ischaemic ulceration

By definition caused by inadequate blood supply “large \ small artery obliteration”

In elderly , who also have symptoms of coronary vascular disease.

Men predominate

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


Neuropathic ulceration

Neuropathic ulceration

Deep penetrating ulcer which occur over pressure point, but the surrounding tissue are healthy and have good circulation.

Diagnostic features:-

1- painless

2- surrounding tissues are unable to appreciate pain

3- surrounding tissues have normal blood supply


Wounds ulcers fistulae cysts

Cont …

  • Causes:-

  • peripheral nerve lesions “diabetes ,nerve injuries”

  • Spinal cord lesions “spina bifida,tabes dorsalis”


Venous ulceration

Venous ulceration

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

Fistulas


Definition

Definition

Fistulas is an abnormal communication between two epithelial or endothelial surfaces


Types of fistula

Types of fistula


Why do they occur

Why do they occur?

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 )


Wounds ulcers fistulae cysts

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


Management

Management

Difficult to treat

Is complex and usually surgical

Depend on the site of the fistula


Treatment

Treatment

Conservative :

The mainstays of medical management are:

- nutritional support

- meticulous collection of fistulous discharge

- skin-stoma care

- control of sepsis


Wounds ulcers fistulae cysts

Surgical :

The absolute indications for operative intervention are :

- intestinal distal obstruction

- peritonitis

- abscess formation

- bowel discontinuity

- presence of malignant disease

- persistent inflammatory bowel disease


Cysts

Cysts


What is a cyst

What is a cyst?

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


What are the causes of a cyst

What are the causes of a cyst?

Cysts are usually formed through one of these mechanisms:

Obstructions to the flow of fluid

Infections and chronic inflammations

Tumors

Genetic (inherited) conditions

Defects in developing organs in the embryo


Examples of cysts

Examples of cysts

Thyroglossal cyst

Ovarian cyst

Sebaceous cyst


Treatment1

Treatment

Usually surgical - Cystectomy


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