Trophic Ulcer

The trophic "leer is the "Ein or mucusa defect Without trend to healing
{sometimes involving the adjacent tissues) due to the Local necrosis. This condition is by
the chronic circulation disorders or dencrvation of the affected areas, Thcrc are arterial,
venous and neurotrophic ulcers.

Signs and symptoms

The vast majority of the tropical ulcers occur below the knee, usually around the ankle. They may
also occur on arms. They are often initiated by minor trauma, and subjects with poor nutrition are
at higher risk. Once developed, the ulcer may become chronic and stable, but also it can run a
destructive course with deep tissue invasion, osteitis, and risk of amputation

Complication
 Skin color: Rarely, Jungle rot will result in complications with skin pigmentation. It has
been known to leave the victim with different colors such as bright red, blue, green,
and a rare color change of orange.
 Deep tissue invasion - Infection may spread deep to the subcutaneous tissue, but
rarely involve the bone[6]
 Chronic ulceration - characterised by thick rim of fibrous tissue around the ulcer
edges

Treatment

 Antibiotics: In early stages, penicillin or metronidazole are used in combination with

topical antiseptic.[5]
 Improved nutrition and vitamins.[5]
 Non-adherent dressings and elevation of limbs.[5]

What causes trophic ulcers?

slideshare.net
 Mixed trophic ulcers. Mixed trophic ulcers - the result of the influence of
several etiological factors on the process...
 Hypertensive-ischemic trophic ulcer. Hypertensive-ischemic trophic
ulcer (Martorel) is not more than 2% of all...
 Piogenic trophic ulcers. Piogenic trophic ulcers occur against the
background of nonspecific purulent soft tissue...
  Post-traumatic trophic ulcers. Posttraumatic trophic ulcers are a rather
heterogeneous group of chronic skin defects...

Fistula
A fistula is an abnormal connection between vessels or organs that do not usually connect. It
can be due to a disease or trauma, or purposely surgically created

Classification
Various types of fistulas include:

 Blind: Only one open end; may also be called sinus tracts.[5]

 Complete: Both internal and external openings.[5]
 Incomplete: An external skin opening that does not connect to any internal organ. [5]
Although most fistulas are in forms of a tube, some can also have multiple branches

Causes

 Disease: Infections including an anorectal abscess and inflammatory diseases

including Crohn's disease and ulcerative colitis can result in fistulas.[9][10] Fistulas to
the anus may occur in hidradenitis suppurativa.[11] In women, fistulas can also occur
following pelvic infection and inflammation.[9]
 Surgical and medical treatment: Complications from gallbladder surgery can lead
to biliary fistulas.[citation needed] As well as being congenital or resulting from
trauma, arteriovenous fistulas are created purposefully for hemodialysis.[6] Radiation
therapy to the pelvis can lead to vesicovaginal fistulas. [9]
 Trauma: Prolonged childbirth can lead to fistulas in women, in whom abnormal
connections may occur between the bladder and vagina, or the rectum and vagina.
[9]
 An obstetric fistula develops when blood supply to the tissues of the vagina and the
bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die
and a hole forms through which urine and/or feces pass
uncontrollably. Vesicovaginal and rectovaginal fistulas may also be caused by rape,
in particular gang rape, and rape with foreign objects, as evidenced by the
abnormally high number of women in conflict areas who have suffered fistulae. [12][13] In
2003, thousands of women in eastern Congo presented themselves for treatment of
traumatic fistulas caused by systematic, violent gang rape, often also with sharp
objects that occurred during the country's five years of war. So many cases have
been reported that the destruction of the vagina is considered a war injury and
recorded by doctors as a crime of combat. [14] Head trauma can lead to perilymph
fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas.

Treatment[edit]
Treatment for fistula varies depending on the cause and extent of the fistula, but often involves
surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily
covered, using a fibrin glue or plug. Catheters may be required to drain a fistula. [3]
Surgery is often required to assure adequate drainage of the fistula (so that pus may escape
without forming an abscess). Various surgical procedures are used, most commonly fistulotomy,
placement of a seton (a cord that is passed through the path of the fistula to keep it open for
draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of
the fistula to keep feces or other material from reinfecting the channel).

BEDSORE
Pressure ulcers, also known as pressure sores or bed sores, are localised damage to the
skin and/or underlying tissue that usually occur over a bony prominence as a result of usually
long-term pressure, or pressure in combination with shear or friction. The most common sites
are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected,
such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

Cause
There are four mechanisms that contribute to pressure ulcer development: [3]

1. External (interface) pressure applied over an area of the body, especially over

the bony prominences can result in obstruction of the blood capillaries, which
deprives tissues of oxygen and nutrients, causing ischemia (deficiency of blood
in a particular area), hypoxia (inadequate amount of oxygen available to the
cells), edema, inflammation, and, finally, necrosis and ulcer formation. Ulcers
due to external pressure occur over the sacrum and coccyx, followed by the
trochanter and the calcaneus (heel).
2. Friction is damaging to the superficial blood vessels directly under the skin. It
occurs when two surfaces rub against each other. The skin over the elbows can
be injured due to friction. The back can also be injured when patients are pulled
or slid over bed sheets while being moved up in bed or transferred onto a
stretcher.
3. Shearing is a separation of the skin from underlying tissues. When a patient is
partially sitting up in bed, their skin may stick to the sheet, making them
susceptible to shearing in case underlying tissues move downward with the body
toward the foot of the bed. This may also be possible on a patient who slides
down while sitting in a chair.
4. Moisture is also a common pressure ulcer culprit. Sweat, urine, feces, or
excessive wound drainage can further exacerbate the damage done by
pressure, friction, and shear. It can contribute to maceration of surrounding skin
thus potentially expanding the deleterious effects of pressure ulcers.

Classification
Stage I: Intact skin with non-blanchable redness of a localized area usually over a bony
prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the
surrounding area. T

 Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a
red pink wound bed, without slough. May also present as an intact or open/ruptured
serum-filled blister. Presents as a shiny or dry shallow ulcer without slough or
bruising. This stage should not be used to describe skin tears, tape burns, perineal
dermatitis, maceration or excoriation.
  Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone,
tendon or muscle are not exposed. Slough may be present but does not obscure the
depth of tissue loss. May include undermining and tunneling. 

 Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle. Slough
or eschar may be present on some parts of the wound bed. Often include undermining
and tunneling. The depth of a stage 4 pressure ulcer varies by anatomical location.

 Unstageable: Full thickness tissue loss in which actual depth of the ulcer is completely
obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or
black) in the wound bed.
 Suspected Deep Tissue Injury: A purple or maroon localized area of discolored intact
skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or
shear.

Treatment

Simple bed sores can heal within few weeks of treatment, but severe sores may need
surgery. The treatment process of simple sores include 1. Negative Pressure Wound
Therapy Negative pressure wound therapy or vacuum assisted therapy is a procedure
that includes the attachment of a suction tube to the bed sore.
Reducing pressure

The first step in treating a bedsore is reducing the pressure and friction that caused
it. Strategies include:

 Repositioning. If you have a bedsore, turn and change your position often.
How often you reposition depends on your condition and the quality of the
surface you are on.

 Using support surfaces. Use a mattress, bed and special cushions that help
you sit or lie in a way that protects vulnerable skin.