Ulcers

WHAT IS AN ULCER?
An ulcer is a break down or loss of normal tissue. This tissue usually functions to protect deeper layers of tissue from factors that are not tolerated by the body, therefore blocking them from invading into those deeper layers. Ulcers can be staged by the following method:

Stage 1
A stage 1 pressure ulcer is an observable pressure-related alteration of intact skin whose indicators is compared to the adjacent or opposite area on the body may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer present as a defined area of persistent redness in lightly pigmented skin, whereas in darker tones, the ulcer may appear with persistent red, blue, or purple hues.

Stage 2
Partial-thickness skin loss involving the epidermis or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage 3
Full-thickness skin loss involving damage or necrosis of subcutaneous tissue, which may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage 4
Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or support structures (for example, tendon or joint capsule). Tunneling and sinus tracts may also be associated with stage 4 pressure ulcers. Bone infection can also be associated with this stage.

DIAGNOSTIC TESTING
Depending on the severity of the ulcer and complications associated with it, there are many tests that can be performed. Cultures are taken when a wound is suspected of being infected or has obvious infection. This is done to determine the type of antibiotics to be prescribed. Imaging including x-ray (which can be done in our office) and MRI are done to determine the depth and severity of the ulcer and to determine if the bone is also affected by this problem. If poor circulation is suspected, then a vascular test is performed in our office to determine how much or how little the circulation is contributing to the development and healing of the ulcer.

WHAT ARE THE CAUSES OF ULCERS?
There are several ways ulcers can develop. We are specially trained in wound care in order to determine what the underlying cause of the ulcer is in order to make a proper diagnosis and develop an appropriate treatment plan. Below are the four main reasons ulcers develop:

Arterial: This type of ulcer is due to poor blood flow to the lower extremity. This type of ulcer can be very painful and are usually found on the tips of toes, lower legs, ankle, heel and top of the foot. They can very easily become infected.

Neuropathic: This is when a patient has loss of sensation in the feet. It is commonly seen in people with diabetes but it can be caused by other reasons such as chronic alcohol abuse. These ulcers are generally seen under weight bearing areas and often will begin as a callus or a corn.

Decubitus: This type of ulcer is caused by excessive prolonged pressure on one area of the foot. The most common place to see this type of ulcer is in a person confined to bed and they occur on the backs of the heels.

Venous: This type of ulcer is due to compromised veins. Veins are the vessels that take fluid out of the legs and back up to the heart. Veins have small valves that allow blood to flow only one way, back up to the heart. The valves normally block the tendency for gravity to pull the blood back down to the legs. Sometimes the valves leak or cease to work at all. If the valves do not work, then the fluid pools down in the legs, causing swelling. This swelling leads to increase pressure in the venous system, producing discoloration of the leg and eventually this lead to ulceration. They are commonly seen around the inside of the ankle and are slow to heal.

HOW CAN I HEAL MY ULCER?
You should immediately seek the advice of a wound care specialist for treatment of your ulcer. If an ulcer goes undiagnosed and becomes chronic, its treatment can be more complicated. Therefore early detection is the key. After seeing your doctor, the next step would be to follow the instructions dispensed to you very carefully so that the treatment of the ulcer does not become further delayed.

HOW WILL MY DOCTOR HEAL MY ULCER?
Proper diagnosis of the cause of the ulcer is the key and after careful inspection of the wound, we will make recommendations in your wound care. If needed special dressings and medications will be ordered for you. If you are unable to care your ulcer, depending on eligibility, a nurse can be sent to your home to help in the treatment of your ulcer. Depending on the data from the diagnostic exams performed, referral to another specialist might be necessary. This could include a vascular specialist, an infectious disease specialist, or a consultation with your diabetes doctor. In appropriate situations we can also use bio-engineered skin graft substitutes to achieve faster healing of your wound. This new technology prevents pain and complications from obtaining skin grafts from another part of your body.

PREVENTION FOR FUTURE OCCURRENCE
Finding the underlying cause of the ulcer is the answer. Once we know what could have contributed to your ulcer we can try to treat it. Diabetics would have to maintain the blood sugars and wear special inserts in their shoes. Individuals with venous insufficiency should wear compressive stockings to control their swelling. And candidates of vascular intervention used to treat their ulcer would need to have routine screenings to monitor the status of their circulation. Ultimately, routine visits to your wound care specialist to monitor your skin integrity would also be advised.

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