Varieties of ulcers:

1. Ulcers at chronic venous insufficiency (posttrombotic, varicose, at innate venous displasia)

2. Ischemic ulcers (atherosclerosis, endarteritis, diabetic angiopathy, syndrome of Mortarely).

3. Ulcers witch are caused innate and purchased arteriovenous connections (posttraumatic arteriovenous fistula, innate arteriovenous fistula at the syndrome of Parks-Veber)

4. Posttraumatic ulcers (burns, bedsores, scalped wounds)

5. Neurotrophic ulcers (traumas and illnesses of nervous system)

6. Ulcers on soil of genera diseases (collagenosess, illness of exchange, blood, Luis, TBC, splanchnopathies)

7. Ulcers on soil local infectious, mycosis and parasitogenic process (phlegmon, necrotizing form of erypsipelatous inflammation, parasitogenic).

Phases of course:

1. The pre-ulcerous state is dystrophic changes of tissues.

2. Necrosis and inflammation of skin and adjoining tissues.

3. Formation of defect

4. Cleaning and regeneration

5. Epithelization and scarring

Morphology. A bottom is formed granulations, which can be covered a fibrin, detritus. A granulation billow passes to the layer of hard connecting tissues. Round an ulcer there is heterospecific inflammation.

Clinic. Sizes from microscopic (helcoma) to 10-20 cm in a diameter (ulcers of shin at venous of lower). Edges of ulcer can be even, soft, hard. A bottom can be pale, bloodshot, greasy (at lues), covered granulations, fibrin, detritus. Excretions can be serosal, festerings, hemorragic. In the case of progress of disintegration of tissues observed the so-called phagedenas, in the case of distribution of numbness – gangrenous. Sometimes an ulcer can have a characteristic kind at lues is over third of shin, greasy bottom, clear edges; there is a flat surface at TBC with hard edges.

Complication of ulcers

• eczema, pyoderma, cellulites, mycosis, erysipelas inflammation, indurations of skin and hypoderm

• thrombophlebitis, second lymphedema

• bleeding

• perforation of ulcer declivous organ (for example, stomach|), penetration in surrounding organs (for example, ulcers of duodenum in the head of pancreas)

• parafunction organ

• malignization

Treatment

1. Removal of reasons which draw the origin of ulcer:

• saphenectomy – at varicose expansion of vena saphena;

• treatment of specific infection

• resection of stomach together with an ulcer

2. Conditioning, cooperant a regeneration:

• bed mode with upper position of feet;

• careful treatment of skin round an ulcer;

• providing of outflow of tissue| liquid from an ulcer in a bandage (osmotic active substance);

• fight against an infection (antiseptics).

• cleaning of ulcer from necrotizing;

• after cleaning of ulcer from necrosis are bandages with neutral ointments 1 time in 3-6 days;

• presence of hypergranulations (nitrate of silver);

• rational feed;

• exercise therapy;

• immunotherapy;

• operative closing of defect of covers

Methods of the surgical closing of ulcers

Preparation. Cleaning of ulcers from necrosis, stop of festering process, liberation of ulcer from the pathologically changed granulations and scars which hinder blood circulation of bottom and walls of ulcer.

Plastic closing of defect by a skin. Use shreds (pieces) on a leg or free the plastic arts.

Method of Yatsenko-Reverden. Fence of pieces of skin by a diameter 0,3–0,5 cm from the external surface of thigh, shoulder or abdomen and laying on-the-spot defect.

Method of Tirsh. A fence of ribbons of skins which include epidermis and apexes of mammilla layer. Length them depends on the sizes of defect, width not more than 3 cm.

Method of Louson-krauz. Considerable on sizes transplants of epidermis, which fix guy-sutures the edges of defect.

Method of Douglas. Carving of groups punch on the stretched skin in the distance 1,5 cm Prepare a shred, abandoning groups on maternal soil. A shred-sieve is fixed to the edges of defect.

BEDSORES (decubitus)

Bedsore is a necrotic process which takes a place for hyposthenic patients in areas which have permanent pressure.

Etiology and pathogenesis. Main reason is an external (in relation to the staggered area) compression (exogenous bedsores) or neurotrophic changes of tissue (endogenous bedsores). There is violation of circulation (ischemia) of blood and subsequent necrosis at a compression. Bedsore is a variety of gangrene.

A trophism, metabolism of tissues changes at neurotrophic changes (violation of trophic innervation), that also conduces to development of necrosis.

Factors which assist development of bedsore

1. Atrophy of hypoderm is instrumental in the increase of pressure on salient parts of body.

2. Not mobility seriously sick instrumental in permanent pressure on the same areas of body.

3. General violations of hemodynamics because of main disease .

4. Metabolic disorders.

An example is a prelum by a gypseous bandage by part of body, prosthetic appliance, extraneous body on a vessel, by a stone on the wall of gall-bladder, by an uncomfortable shoe.

Phases of course:

1. Devascularization and trophism

2. Necrosis of skin

3. Formation of defect

CLINIC. A skin at the beginning is pale, then - cyanochroic, oedematous. Further is removing a layer by the layer of epidermis and formation of blisters. Further is necrosis of skin. After his tearing away a defect appears with a bottom, covered festering-necrotizing the masses (by detritus). Appearance of dystrophic granulations is further possible (pale, fine-grained, dim).

Typical localizations are an area of sacrum, spinal sprouts of vertebrae, corners of shoulder-blades, back of head, olecranons, front overhead awn of ileum, patella, heel, front surface of shin (cutting edge of large tibia).

TREATMENT – on the rules of treatment of festering-necrotizing processes

Prophylaxis.

1. Prevention of the protracted compression: inflatable circles, B/Ss with millet, flax, frequent change of position of body, sectional pneumatic mattresses.

2. Careful care of patient and his|its| skin (bathing, wiping out salicylic alcohol)

3. Clean bed linen, absence of folds.

Fistulas

Fistula is pathological motion which connects organs, perigastriums or deeper located tissues, with the external surface of body or with the cavity of internal organ| Through a fistula the products of pathological process (leave to rot, sequester), secret or content of the proper organ are selected (gastric juice, bile|, wetting, pancreatic juice).

Classification

Originally:

1. innate

2. purchased: