The loss of surface tissue over an area is called an ulcer. This loss is due to death of the cells. There are several specific types of ulcers which may occur. They are due to one of two primary conditions—either infection or interference of blood supply.
Infectious ulcers are those which are caused by germs. They may have been initiated by another process (such as injury, bum, incision, or tumor), but the major hindrance to their healing and the continued destruction of cells is by the germs present. Specific types of ulcers may be caused by the entrance of specific types of germs, such as tuberculous ulcers and syphilitic ulcers. Certain fungi form typical ulcerations of the skin. Infectious ulcers extend as the germs invade and kill adjacent cells. The basic treatment of these ulcers must be directed at ridding the area of its germs. Medicants and dressings are applied locally and antibacterial drugs must be given which pass through the blood to reach the germs beneath the ulcer surface. When the germs have been eliminated, the ulcer readily heals.
Ulcers due to deficient circulation are seen in a number of circulation diseases. Whenever cells do not receive oxygen and their other required nutriments from the blood stream, they promptly die. The dead cells on the surface slough off, leaving a denuded surface. Due to the impaired blood supply, healing does not ensue as it ordinarily would. The treatment of these ulcers must be carried out in conjunction with the treatment of the circulation disease. They must be protected against invasion by germs so that an infectious type of ulcer does not further complicate the process. A common type of circulation deficiency ulcer is the varicose ulcer, which results from varicose veins of the leg. Here the oxygen-depleted blood is not carried away rapidly enough to allow fresh blood to enter. Correction of the diseased veins is usually necessary before healing of the ulcer takes place. Another form is the diabetic ulcer, where the tissue metabolism is not normal because the constituents of the blood are not proportionately correct; the cells die to result in ulcer formation. Control of the diabetic is necessary to gain healing of this ulcer. Some ulcers are a combination of several causes.
Healing of ulcers is prompt when their causative factors have been eliminated. The ulcer which has been ridded of germs and assured adequate blood supply may heal by formation of granulation tissue which turns to scar, or by formation of a scab over it, under which healing occurs. The skin will regenerate to bridge across most ulcers smaller than the size of a fifty-cent piece. Others will heal only by scar or will necessitate a graft to provide a pliable covering of skin.