What Are Ulcers?
Ulcers develop as open wounds on the skin. Often, they take a vaguely circular shape (unlike a more linear cut or abrasion). The initial injury to the skin may come from a laceration, scrape, blister, pressure breakdown, or general skin weakness. In patients with diabetes or other conditions that cause loss of nerve sensation to the area, a lack of awareness about the initial wound and its duration often make the problem worse and increase the chances that an ulcer will form.
The failure of simple wounds to heal (and thus their tendency to ulcerate) may stem from a variety of other conditions as well. Many diseases that cause poor blood flow, that compromise blood vessels or that weaken the immune system may mean that an individual's healing process is not quick and adequate enough to prevent the skin injury from becoming a chronic, non-healing lesion.
In the skin, this means an ulcer will develop. These wounds are defined by:
- loss of dermatologic integrity of the area;
- secondary infection of the site by bacteria, fungus or virus;
- generalized weakness of the patient;
- and, of course, delayed healing.
As ulcers worsen, their size and depth increases, and infection can spread to surrounding areas or into the blood stream, causing sepsis. Such severe ulcers bring the danger of gangrene (and possible need for amputation) and blood toxicities (which can cause generalized organ and system failure).
Patients with diabetes are particularly prone to ulcers, due to nerve damage and poor circulation in the extremities. Foot ulcers are of greatest concern because they are so common. Skin on the feet endures the greatest mechanical stress, and feet are the most likely extremity to suffer nerve and circulation loss as a result of diabetes. Plus, foot ulcers aren't always easy to spot, including on causal inspection. For all these reasons, diabetic foot ulcers can develop in subtle and insidious ways, eventually leading to more serious infection and debilitation, if not cared for properly. Doctors often define diabetic foot ulceration as full-thickness penetration of the dermis (skin) of the foot in a person with diabetes.
Pressure ulcers are also known as pressure sores, bedsores and decubitus ulcers. These are lesions caused by unrelieved pressure to any part of the body, especially portions over bone or cartiledge. Medical providers often classify pressure ulcers using the Wagner system, with the severity labeled 1 (superficial) through 5 (most severe).
Healing & Treatment
Wound specialists seek to help patients achieve wound healing without the use of surgery. Important care steps include:
- debridement - removal of dead tissue to facilitate external healing and prevent re-infection;
- infection control - use of antiseptics and antimicrobobials, along with frequent changing of dressings to help keep the wound clean and protect it from further infection;
- pressure relief - cushioning, wrapping, and patient repositioning (or adjustment of bed, chairs, shoes or clothing, or any devices used for mobility) to prevent mechanical stresses to the wound;
- and nutritional support - administering vitamins and minerals (particularly vitamin C, vitamin A, and zinc) in appropriate doses and ensuring adequate protein.
For some patients, hyperbaric oxygen therapy (HBOT) can also serve as an essential form of care.
Anyone who develops an ulceration that does not steadily heal should seek medical attention without delay, so that knowledgeable clinicians can determine the cause and, as needed, help to initiate a course of care and treatment in a timely fashion. Lourdes' wound-care centers offer the most advanced therapies and treatments for problem wounds such as diabetic ulcers and pressure ulcers.