What is it?
An ulceration is an absence of or
defect in the normal lining of the skin layers (epidermis
and dermis). In a sense, an ulceration is a hole or cavity in the skin that
may be wet or dry and potentially, very resistive to healing. Patients with
diabetes, poor circulation and those that are bedridden may have increased
tendencies to develop ulcerations. The symptom level, clinical appearance,
and response to therapy are largely dependent upon the type and location of
the ulceration and the health of patient.
What causes them?
There are many types of
ulcers including those caused by loss of sensation of the skin, decreased
blood flow, pressure to a specific area of the foot and
due to problems with the valves in the veins.
The diabetic ulceration
is caused by an unhealthy condition of the nerves. Because the nerves are
debilitated, they do not function properly and result
in a loss of sensation. A diabetic patient may step on a needle or other
object in the shoe and not even be aware of the problem due to reduced
sensation. The skin will eventually
break down and result in an ulceration.
Ischemic ulcerations are
ulcers that are caused by decreased blood flow and poor blood supply to the
feet due to calcified arteries or blockages of the blood vessels. These are
the most painful of all the ulcers. Because the skin is not getting the
nourishment it needs to survive from the arteries, it begins to die. This
often leads to an ulceration.
A pressure ulceration is
caused when a portion of the foot is left in contact with an area such as a
bed mattress for an excessive period of time. This type of ulceration is
commonly seen in patients that are bedridden and unable to move on their
own. The pressure to the area cuts off the blood supply, which can cause
tissue death leading to an ulceration.
A venous stasis
ulceration occurs due to an incompetent or faulty valve between the
superficial and deep veins in the legs. This results in fluid being backed
up into the superficial veins. Eventually there is too much fluid in the
leg. The fluid has nowhere to go and so it begins to weep onto
the skin. Eventually an ulceration will occur.
How do you treat them?
There are many different
treatments for ulcers and the type of ulceration involved largely determines
the specific method of care. In general, ulcers are treated with debridement
(removal) of the surrounding tissue and any nonviable tissue. This will help
relieve pressure from the ulcer. Some patients are treated with non-weight
bearing of the foot to help decrease pressure on the ulcer. Topical wound
gels and creams are also used to keep certain ulcers clean and hydrated.
Some gels even help remove dead tissue. The treatment of ischemic
ulcerations may require revascularization procedures by a vascular surgeon
to increase the blood supply to the feet. Venous stasis ulcers are often
treated with compression dressings to help squeeze the fluid out of the legs
and back into circulation. These ulcers are also treated with wound gels.
Appropriate ulcer therapy can be very effective but often requires time,
patience and cooperation on the part of the patient.