Wounds, ulcers, fistulae & cysts

1. Wounds, ulcers, fistulae & cysts

2. wounds

3. Mechanism of injury • Traumatic wounds • Sharp, penetrating • Blunt • Bullet • Surgical wounds

4. Types of wounds • Cut wounds incised • Lacerated wounds • Crushed wounds • Wounds with skin loss

5. Types of Suturing • Primary suturing • Excision and primary suturing • Delayed primary suturing • Secondary suturing • Skin grafting

6. Elements of Wound Healing 1- Contraction 2- Connective tissue formation (granulation tissue) 3- Epithelization

7. Surgical Wounds Clean Clean contaminated Contaminated Dirty

8. 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

9. Complications of Wounds: • Wound infection • Wound dehiscence • Hyper trophied scar, keloid

10. Principles of wound management Correct all local and systemic factors that might impair wound healing Wound toilet Wound dressing Antibiotics if infected

11. Ulcers

12. 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

13. 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

14. 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.

15. causes Bacterial , viral & fungal infection Cancer both primary & secondary Venous stasis Arterial insufficiency Diabetes Rheumatoid arthritis Loss of mobility

16. Description Site Size Shape Base Edge Tenderness Discharge Surrounding tissue & lymphatics

17. Types Peptic ulcer Mouth ulcer Pressure ulcer (decubitus) Arterial insufficiency ulcer Venous insufficiency ulcer Diabetic foot ulcer

18. 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

21. 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

22. Cont … • Causes:- • peripheral nerve lesions “diabetes ,nerve injuries” • Spinal cord lesions “spina bifida,tabes dorsalis”

25. 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

28. Fistulas

29. Definition Fistulas is an abnormal communication between two epithelial or endothelial surfaces

30. Types of fistula

31. 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 )

32. 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

34. Management Difficult to treat Is complex and usually surgical Depend on the site of the fistula

35. Treatment Conservative : The mainstays of medical management are: - nutritional support - meticulous collection of fistulous discharge - skin-stoma care - control of sepsis

36. Surgical : The absolute indications for operative intervention are : - intestinal distal obstruction - peritonitis - abscess formation - bowel discontinuity - presence of malignant disease - persistent inflammatory bowel disease

37. Cysts

38. 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

40. 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

41. Examples of cysts Thyroglossal cyst Ovarian cyst Sebaceous cyst

42. Treatment Usually surgical - Cystectomy