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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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Presentation Transcript
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 contaminated



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


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 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
  • 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

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.

Bacterial , viral & fungal infection

Cancer both primary & secondary

Venous stasis

Arterial insufficiency


Rheumatoid arthritis

Loss of mobility









Surrounding tissue & lymphatics


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

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 is an abnormal communication between two epithelial or endothelial surfaces

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 )


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


Conservative :

The mainstays of medical management are:

- nutritional support

- meticulous collection of fistulous discharge

- skin-stoma care

- control of sepsis


Surgical :

The absolute indications for operative intervention are :

- intestinal distal obstruction

- peritonitis

- abscess formation

- bowel discontinuity

- presence of malignant disease

- persistent inflammatory bowel disease

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


Genetic (inherited) conditions

Defects in developing organs in the embryo

examples of cysts
Examples of cysts

Thyroglossal cyst

Ovarian cyst

Sebaceous cyst


Usually surgical - Cystectomy