Study of the ulcers of the foot

Shashidhara, P (2013) Study of the ulcers of the foot. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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BACKGROUND: A chronic ulcer of the foot is a frequent condition, with prevalence in the population over 60 years of age. The incidence of ulcers is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity and diabetes. Ulcers can be defined as ‘break in the continuity of the covering epithelium either skin or mucous membrane due to molecular death’. In general, the slow healing tendency is not simply explained by depth and size, but caused by an underlying pathogenetic factor that needs to be removed to induce healing. The main causes are varicose veins, lower extremity arterial disease and diabetes, less frequent conditions are infection, vasculitis, skin malignancies and ulcerating skin diseases such as pyoderma gangrenosum. For a proper treatment of patients with foot ulcers it is important to be aware of the large differential diagnosis of foot ulceration and to effectively manage the conditions. AIMS AND OBJECTIVES: • To compare and analyze the distribution of age, sex, systemic disease and location of the ulcer among 100 cases of the study group. • To study the clinical features of various types of foot ulcers. • To study the usefulness of applied investigations. • To identify the methodology to effectively manage the condition. • To identify the steps to prevent as far as possible foot ulcers in high-risk individuals prone to the condition. METHODS: Prospective study of 100 cases of chronic foot ulcers admitted at Tirunelveli medical college Hospital, Tirunelveli, during the period March 2011 to March 2012, with regular dressing, debridement, treating the underlying systemic disease, skin grafting and amputation were done. RESULTS: In a study group of 100 cases, most of the patients with leg ulcers had an underlined systemic disease such as diabetes mellitus, varicose veins, arterial occlusion secondary to atherosclerosis, leprosy and malignancy. SUMMARY: Clinical study of ulcers of the leg was carried out at Tirunelveli Medical College Hospital, Tirunelveli from March 2011 to March 2012. The study reveals certain important data. The highest number of cases was found to be ulcer of the foot associated with diabetes mellitus, ulcer due to venous valve incompetence, ulcers due to arterial occlusion secondary to atherosclerosis and TAO. Tropic ulcers associated with Diabetes Mellitus and other ulcers following snakebite and certain infections like pyoderma, gangrenosa. Diabetic ulcer being more common in males, more prevalent in patients above the age of 51 years and above, more often seen in left limb, venous ulcer was very commonly seen in patients who were presenting with venous valve incompetence resulting in venous congestion commonly seen saphenofemoral junction incompetence and perforator incompetence predominantly seen in males patients between 31-40 years of age in the gaiter zone. Atherosclerosis was found to be the common cause of arterial ulcer due to arterial occlusion with high cholesterol levels. The only other arterial ulcer was due to TAO predominantly seen in middle-aged individuals only in the foot. Among the other ulcers, a few cases with snakebite resulting in cellulitis and tissue necrosis had extensive skin loss leading to non-healing ulcer. A few were due to sutured wound, which got infected, and tissue necrosis resulting in skin loss leading to non-healing ulcer. The commonest organisms cultured from the wounds was found to be staphylococcus, streptococcus, pseudomonas and klebsiella. Though the causative factors are varied, diabetes mellitus and varicose veins were by far the more common factors. Underlying vascular disorders are the main etiological factors for foot ulcers with diabetes forming a major risk factor. Diabetes was the commonest disease associated with foot ulceration. Thus, the study of various cases of foot ulcers arouses lot of interest and is mind bogging as far as the treatment of these cases are concerned. What with the availability of arsenal of investigation wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of foot ulcers. Skin grafting when it becomes a choice for chronic ulcers with wide defects is indeed the right one.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Chronic non-healing ulcer ; Diabetic leg and foot ulcer ; varicose ulcer ; Tropic ulcer ; Arterial ulcer ; Malignant ulcer.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:55
Last Modified: 09 Jun 2018 17:55

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