Ulcer

An ulcer is a localised defect in the continuity of an epithelial surface without any tendency to heal. It is usually associated with an inflamed base of granulation tissue with or without necrotic slough.

The majority is chronically inflamed; the slough at their base represents inadequate drainage. Acutely inflamed ulcers may have an outer rim of cellulitis.

Ulcer must be differentiated from erosion which is an epithelial defect with loss of superficial layers, but the basal layers are intact.

Classification of Ulcers

Iatrogenic ulcers

wound breakdown post-operatively and in irritant fluid extravasating is called Iatrogenic ulcers.

Non-specific ulcers

Non-specific ulcers are Traumatic ulcers including secondary stress ulcers.

Malignant ulcers

Malignant ulcers observed in skin and gastrointestinal tract.

Ischemic ulcers or Decubitus ulcers

Ischemic ulcers or Decubitus ulcers are due to continuous pressure which interferes with supply of nutrition to local tissues leading to pressure or bed sores.

Infective ulcers

Infective ulcers are due due infectious agents. examples of these types of ulcers are viral, tuberculosis, and secondary e.g. due to drainage of deep focus.

Neuropathic ulcer

Neuropathic ulcer seen in diabetes.

Etiology of Ulcers

• Repeated and continuous irritation of wound. For example- Traumatic ulcer, bed sore.
• Secondary infection of the site by bacteria, fungus or virus with which the tissues cannot effectively combat.
• Insufficiency of nerve and blood supply to the part.
• Presence of necrotic tissue or foreign body in a wound.
• Specific diseases like tuberculosis, glanders, and ulcerative lymphangitis.
• Presence of neoplasm. For example- Rodent ulcers.

Common sites in animals for ulcers

• Cattle: yoke
• Horse: saddle place, elbow, limbs
• Dog: root of tail, tip of ears, and cornea of eye

Symptoms of Ulcers

The edge of ulcer may be raised or in level with the surrounding skin and rugged.

The center of the lesion may be flat or concave, and may show necrotic spots.

Granulations are pale or blue in colour depending upon the form. The discharge may be serous, purulent or greyish in color.

Treatment of Ulcers

The specific treatment of an ulcer is dependent on the subtype of the ulcer. These treatment options considered for the ulcer-

• Elimination of the cause adversely affecting the course of ulcerative disease and stimulation of regenerative processes at the affected site.
• Astringent or caustic applications for ulcers with excessive or unhealthy granulations. For example- copper sulphate, silver nitrate, carbolic acid applied on the ulcers.
• Thermo-cautery with red hot iron to destroy unhealthy tissue which promotes granulation and cicatrisation.
• Bier’s hyperaemic treatment can be done.
• Antibiotics are only indicated for infected ulcers in which there is evidence of spread around the margin. For example a cellulitic rim and there may be ongoing systemic infection in case of tuberculosis.
• Exposure to ultraviolet rays to stimulate circulation and to destroy micro-organisms.
• For large deficits or prolonged ulcers with little evidence of healing, further surgical intervention may be indicated. For example skin grafts and rotational flaps.