Approach to Foot Ulcer
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APPROACH TO FOOT ULCER
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DEFINITIONAn ulcer is a break in the continuity of the
covering epithelium skin or mucous membrane due t0 molecular death of the cells associated with either acute or chronic inflammation.
Legs & feet are susceptible to ulcer formation.
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ETIOLOGYTRAUMATICDIABETICARTERIAL VENOUS MALIGNANCY
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OTHER CAUSESERYTHROCYANOID ULCER (BAZIN’S DISEASE)GUMMATOUS ULCERMARTORELL’S ULCERINFECTIVE ULCERS – TB, SYPHILIS,
STAPHYLOCOCCUS, etc.ULCERS COMPLICATING VARIOUS DISEASES
GROSS ANEMIA, POLYCYTHEMIA, LEUKEMIA, RA, PAGET’S, etc.
TROPICAL ULCERYAWSULCER FROM CONGENITAL AV FISTULA
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WAGNER’S CLASSIFICATIONGRADE – 0 : NO OPEN LESION, INTACT SKIN-
IMPENDING ULCER (Callus may be present)
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WAGNER’S CLASSIFICATIONGRADE – 1 : SUPERFICIAL ULCER
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WAGNER’S CLASSIFICATIONGRADE – 2 : DEEP ULCER TO TENDON , CAPSULE
OR BONE
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WAGNER’S CLASSIFICATIONGRADE – 3 : DEEP ULCER WITH ABSCESS ,
OSTEOMYELITIS & JOINT SEPSIS
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WAGNER’S CLASSIFICATIONGRADE – 4 : LOCALISED GANGRENE
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WAGNER’S CLASSIFICATIONGRADE – 5 : GANGRENE OF ENTIRE FOOT
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PEDIS CLASSIFICATION
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HISTORY - APPROACHDESCRIBING ABOUT THE ULCER
TO ASSESS THE ETIOLOGY OF THE ULCER
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SITE
ONSET
DURATION
PROG
RESS
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HISTORY OF PAINFEVER DISCHARGE
COLOUR, AMOUNT, TYPE OF DISCHARGE
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TO ASSESS ETIOLOGYHISTORY OF
TRAUMASENSATION OF FOOTINTERMITTENT CLAUDICATIONDILATATION OF VEINS/ PROLONGED STANDINGLOSS OF APPETITE/ WEIGHTSWELLING IN GROINDIABETES, HYPERTENSION, TUBERCULOSIS,
VENEREAL DISEASEMEDICATION INTAKESURGERY DONE
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ARTERIAL ULCER
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VENOUS ULCER
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MALIGNANT ULCER
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EXAMINATION OF ULCERINSPECTION6 S
SITESIZESHAPESURGACESKINSCAR
NUMBERFLOOREDGE MARGIN
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PALPATIONLOCAL TEMPERATURETENDERNESS OF THE EDGE OR BASE OF
ULCERBASE OF ULCERMOBILITY OF ULCER
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TO CHECKPERIPHERAL PULSATIONPERIPHERAL SENSATIONANY VENOUS DISEASEDRAINING LYMPHNODES
MONOFILAMENT TESTANKLE BRACHIAL INDEX
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DIAGNOSISSIDE, CONDITION OF THE ULCER,
ETIOLOGYEg. Right foot chronic non healing ulcer due
to diabetes.
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CAUSES OF NON HEALING ULCERLOCAL FACTORS
LACK OF ADEQUATE REST LACK OF ADEQUATE
IMMOBILISATION REPEATED TRAUMA REPEATED INFECTION PRESENCE OF FOREIGN
BODY PRESENCE OF SEQUESTRUM PRESENCE OF ARTERIAL
DISEASE PRESENCE OF VENOUS
DEISEASE PRESENCE OF LYMPHATIC
DISEASE PRESENCE OF NERVE
DISEASE
GENERAL FACTORS ANEMIA HYPOPROTENEMIA DIABETES MELLITUS TUBERCULOSIS HYPERTENSION CHRONIC LIVER DISEASE CHRONIC RENAL
DISEASE PATIENT ON STEROIDS MALIGNANCY RADIATION CYTOTOXIC DRUGS
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INVESTIGATIONSLAB INVESTIGATIONS
Complete Blood CountESRFasting/ Post prandial blood sugarPus swab for Culture SensitivityTissue for culture sensitivityEdge Biopsy
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RECOMMENDATION FOR COLLECTING SPECIMENS FOR CULTURE
Obtain culture only if there is clinical evidence of infection,
Debride & cleanse the wound before collecting specimen,
Obtain tissue specimen from ulcer by currettage,
Biopsy of deep tissue or infected bone – c/s,
Avoid sending just wound swab,
Obtain blood culture, if pt. is systemically ill,
Request for gram stained smear of specimen.
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ImagingChest X rayLocal foot X rayArterial and Venous Doppler StudyCT Angiography
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THANK YOUPROF. DR. BARANI RAJKUMAR