Ulcers, sinuses, fistula

MD3 lecture
Definitions
 Ulcer
An ulcer is a discontinuity of an epithelial
surface.
Maybe specific or non-specific.
Maybe benign or malignant
Common types of ulcers
 Pressure ulcers
 Venous ulcers
 Secondary infective ulcers
 Traumatic ulcers
 Neuropathic ulcers-diabetic ulcers.
 Primarily infective eg:Tuberculosis
Syphillis, fungal
Management of ulcers
 Local wound care
 Various dressing material
 Treat the underlying problem
Sinus
 A blind-ending tract that connects a cavity lined by
granulation tissue with an epithelial surface.
 Maybe congenital or acquired.
 Acquired sinuses occur as a result of a retained
foreign body eg suture material, a specific infection
eg. TB
Management of sinuses
 For congenital sinuses they may need specific
management depending on the type.
 Eg pilonidal sinus
 Preauricular sinus
 For acquired sinuses
 Treat the underlying cause
 Explore for possible foreign bodies
Fistula
 An abnormal communication between two epithelial
surfaces. The tract maybe lined by granulation tissue
but may later be epithelialized.
 Fistulae maybe congenital; eg. TOF or acquired eg.
Fistula in ano, Enterocutaneous fistula as a surgical
complication,
Management of fistula

 Specific management depending on type and cause

 eg anorectal fistula
 Tracheo-esophageaal fistula
Necrotising fasciitis
 An infective process
 Polymicrobial synergistic infection
 Organisms
 Streptococcal species
 Streptococcus group B
 Pseudomonas, proreus,bacteroides.
Predisposing factors/conditions
 Diabetes mellitus
 Smoking
 Penetrating trauma
 Immunodeficiency V drug abusers
 Perineal infections
 Skin abrasions/infections, bites, boils
Clinical features
 Swelling of the extremity/site
 Woody edema
 Pain
 Fever
 Subcutaneous crepitus
 Subcutaneous air
 Rapid progression
Progression
 Rapid progression
 Skin/muscular necrosis
 Septic shock
Management
 Resuscitation
 Antibiotics
 Debridement(may have to be serial)