Ulcer

Ulcer is a profound defect in the skin or mucous membrane and underlying tissues, the healing processes of which (development of granulation tissue, epithelialization) are reduced or significantly impaired and are accompanied by prolonged healing. Surface processes in the skin are related to dermatitis, eczema or dermatosis under the influence of professional factors.

What causes an ulcer?

The causes of ulcers are very diverse. Conditionally they can be divided into two groups: the place of the damaging action (endogenous and exogenous) and the generally damaging action (most often, neurotrophic disorders). In most cases, there is a combination of these and other reasons.

What are ulcers?

The following types of ulcers are distinguished clinically and by etiological factor.

Traumatic ulcers, formed with direct damaging effects of high and low temperatures, electricity, radiation energy, exposure to certain chemicals, injuries. In contrast to the slow-regrowing acute manifestations of these effects, the ulcer differs in the duration of the flow (more than two months), the granulation in the ulcer is pale, covered with fibrin, the pathogenic microflora is absent in most cases, the pain syndrome is not expressed.

Trophic ulcers are formed when circulatory disturbances (circulatory type), mostly venous and lymphatic blood flow in: postgrombophlebitic syndrome, varicose veins, and are a manifestation of venous insufficiency; lymphedema, diabetes mellitus (diabetic foot), obliterating diseases of the vessels of the extremities, with the rejection of decubitus. Trophic ulcers often form on the shin and foot, they have a rounded, oval or irregular shape, their sizes are different, sometimes they can be giant or cover the entire leg, the edges are swollen, compacted, with progression more often loose and undercut, the skin around the ulcer is atrophic or, conversely, dense in infiltration, can be cyanotic or have a brown color; The bottom is filled with flaccid, pale granulations covered with detritus; in the absence of a purulent infection, the discharge can be serous, serous-hemorrhagic, sometimes there are erosive bleeding; Pain syndrome is poorly expressed, with the exception of obliterating diseases of the extremities. When joining the infection, tropical ulcers are defined as infected: pain, hyperemia and edema around the ulcer, increased skin temperature, characteristic purulent discharge (more common Pseudomonas aeruginosa - separable blue or greenish color, proteus - with an unpleasant "puffy" smell, staphylococcus - with urocholous odor of discharge).

Allergic and neurotrophic ulcers are classified as the most difficult to treat, as they are by themselves multifaceted in pathogenesis, in addition, they are often combined with a viral, fungal and purulent infection. Usually loose, flat, the edges are raised above the skin in the form of a roller, the skin is thinned, cyanotic hyperemic, there may be bubbles filled with serous or serous-hemorrhagic contents of the granulations, there are almost no ulcers wetting, accompanied by pruritus, there is a link with the allergen more often than production.

Specific ulcers have characteristic features, depending on the microflora that caused their formation. Tuberculosis ulcers are often formed together with the fistula, characterized by slow development, painlessness, granulation pale, forming bridges, which, as regeneration form coarse deforming scars: Syphilitic ulcers are formed after opening the fistula with fistulas with a creamy discharge; ulcer accompanied by characteristic night pain; can be of different sizes, usually of a regular rounded shape, with sheer dense, scalloped edges of a cylindrical shape, usually sharply delineated by a pigmented border of atrophic skin, often with bridges of different size and color; ulcers tend to go deeper, causing disfigurement and even loss of certain organs (nose, eyes, testicles, etc.); heal or tender hems of different depths and colors ("mosaic scar"), or coarse, dense, retracted scar; the border of pigmented and atrophic skin around the healed ulcer is preserved in either case.

Blastomatous ulcers are formed as a result of the disintegration of the primary tumor or, more rarely, of metastases, have an unpleasant and amoric smell. The callousness (callous ulcer) of the edges of a chronic ulcer is very suspicious of malignancy, which must be confirmed or rejected by biopsy of tissues taken from three points - the margins, the wall and the bottom of the ulcer. In general, in all cases, it is necessary to take smears-prints of the bottom of the ulcer on the cytology, which often makes it possible to establish the cause of persistently flowing ulcers.

Ulcerous processes on mucous form even separate diseases: peptic ulcer of stomach and duodenum, ulcerative colitis, blepharitis, bronchiectatic disease, etc. All these ulcerative processes are multifaceted in etiology and pathogenesis. For example, the ulcer of the stomach and duodenum can be formed both under the influence of spirochetes, and under the influence of neurohumoral factors; when exposed to hypoxia (hypoxic ulcer); stress (stress ulcer); disorders of gastric juice secretion (peptic ulcer), under the influence of certain drugs - steroid hormones, salicylates, etc., symptomatic ulcers.

Complications of ulcers include: rough cicatricial deformation of surrounding tissues, which can cause not only a cosmetic defect, but also a violation of limb function or cause stenosis of the outlet stomach; deepening of the ulcers and erosion (erosion) of the vessels can cause bleeding, up to the profuse, although affected in 4 main veins. Ulcers of the stomach and intestines are endangered by perforation, penetration into neighboring organs and tissues, malignancy.

How is the ulcer treated?

Treatment of ulcers should mainly be directed to the underlying disease, so tactics are chosen in each case individually. The surgeon's competence is the treatment of trophic ulcers and complicated gastric ulcer.