Ulcer

Ulcer is a break in the continuity of epithelial surface due to progressive destruction cell by cell.
Ulcer types



Local(tropical )treatment of nonspecific ulcers
Any underlying cause is treated ,e.g . varicose veins, diabetes,arterial disease. Many lotions and nonadhesive applications are used to aid the separation of sloughs ,hasten granulation and stimulate epithelialization.the basic requirements of an ideal dressing are that should :
1-Maintain a high humidity between the wound and the dressing-
2-Remove excess exudates and toxic compounds permit gaseous exchange of oxygen ,carbone dioxide and water vapour. 3- Provide thermal insulation to the wound surface and be impermeable to microorganisms 4--Be free from particles and toxic wound contaminants 5- allow easy removal with no trauma at dressing change 6- Be safe to use and be acceptable to the patient 7- be cost effective.
Antiseptics and topical antibiotics :
Antiseptics can do more harm than goodwhen used inappropriately. They may interfere with normal healing process, are toxic to the fibroblasts, and may permit more virulent organisms to dominate. If a wound need cleaning normal saline warmed to body temperature will be better .if a topical antiseptic is necessary ,aqueous chlorhexidine 1 in 5000 solution is effective against a wide range of Gram + and – organisms and some fungi, but not spores.povidone iodineof broad spectrum of activity but its antibacterial effect is reduced by contact with pus or exudates.flamazine a hydrophilic cream containing sulver sulphadiazine 1% ,broad spectrum antibacterial agent and very effective against Pseudomonus pyocyan useful for prevention of G-ive sepsis in patients with sever burns.
Wound dressings
Hydrocolloid dressings such as Granuflex consist of a thin polyurethane foam sheet bonded on to a semipermeable polyurethane film which is impermeable to exudates and microorganisms. when the dressing comes into contact with wound exudates,it interact to form a gel which expands into the wound.the moist condition produced under the dressing promote angiogenesis and wound healing without causing maceration. They can be used for treating leg ulcer,pressure sore ,minor burns and granulating wounds Small wounds containing dry slough or necrosis ,the dressing prevent loss of water vapor from the surface of the skin,this effectively rehydrate the dead tissue ,which is then removed by autolysis. Most Of dressings are also available wih added properties which Improve their basic function. Kaltostat with a layer of activated charcoal cloth attached.this is effective as a primary dressing in the management of infected malodorous wounds.
Sinuses and fistulas