Ulceration and Treatment

What is an ulcer?

An ulcer is a deep loss of skin, usually on the lower leg or foot. Healing can take weeks or months. Chronic ulcers (present for more than six weeks) are common and become more frequent with increas­ing age.

Types of Ulcers

• Venous ulcer: The most common type of chronic ulcer. Most venous ulcers are caused by poor cir­cu­la­tion due to damaged veins.
• Ischemic ulcer: When arteries become blocked or narrowed an ulcer may develop. A lack of blood flow to the tissues is called ischemia.
• Vasculitic ulcer: Small arteries can become inflamed, and reduce blood flow. Inflammation can be can be caused by a range of conditions.
• Neuropathic ulcer: Damage to the nerves can result in an ulcer. Diabetes is the most common cause of neu­ro­path­ic ulcers.

When some ulcers become extremely infected and cannot heal sometime the limb needs to be amputated.

Treating an ulcer

An ulcer is a very fragile problem that can escalate very quickly if it is not taken care of. Ulcers need to be kept clean and dry.

The area should be washed every day with warm soapy water and dried properly. If using powder or mois­turis­er on the area, it should be absorbed before any dressing is re-applied.

Nursing services can aid in the treatment of wounds by dressing and cleaning the wound on a regular basis. They should be contacted if the patient is unable to care for the wound themselves.

Compression Stockings (Venous & Neuropathic)

It is advised that com­pres­sion stockings with a com­pres­sion of 35mmHg are worn during the day. The com­pres­sion stocking will increase the blood flow and clear the area quicker than bandaging.

A cotton liner should also be worn to protect the ulcer and the skin around the ulcer. The cotton liner is also designed to maintain just enough moisture on the ulcer for it to heal.

Compression stockings need to be replaced every 6 months as the com­pres­sion will start to reduce after this time.

If com­pres­sion stockings cannot be used com­pres­sion bandaging or inelastic wrap should be used every day to increase the blood flow to the area.

How to tell if an ulcer is infected

After the ulcer has healed

Ulcers can take a long time to heal. Once they have healed they can return very quickly if the area is not looked after properly.

Compression stockings should be worn every day, even after the ulcer has healed. When com­pres­sion stockings are worn the blood flow is improved and reduces the likely hood of an ulcer re-occurring.

Regular foot checks should be done to ensure that no ulcers are starting. If an ulcer is starting treatment can start early before the ulcer worsens.

DEBRIDEMENT

What is a debridement?

A debride­ment is the flushing of injected skin with fluid or saline to allow the skin to heal on its own before ampu­ta­tion is needed and the infection spreads.

Flushing of the wound is done at the same time as a debride­ment to allow new skin to form without infection.

AMPUTATION

What is amputation?

Amputation is the removal of an extremity that has become infected or compromised.

Preparing for a procedure

You will be advised of your admission date. Most patients are admitted on the day of the procedure or you may be admitted the night before.

Admission forms for the relevant hospital will be posted. Complete and return them to hospital.

Prior to your surgery the anaes­thetist may either contact you by phone, see you in pre­op­er­a­tive clinic or just prior to surgery.

Fast for 6 hours prior to surgery.

If you are taking an anti­co­ag­u­lant (blood thinner), ie Warfarin/ Plavix, you will be advised when to stop.  Any other med­ica­tions can be continued, unless otherwise ordered.

After Surgery

Immediately after surgery you will be taken back to the ward for mon­i­tor­ing and surveillance.

Nursing staff will dress the wounds regularly. Allied Health will review your situation and a pros­the­sis will be fitted if necessary.

You may be in hospital for 3—5 days.