general management

Last reviewed 01/2018

The specific treatment of an ulcer is dependent on the subtype; there are several steps which may be applicable to all ulcers:

• determination of aetiology:
• accurate description can aid diagnosis - see submenu
• complete physical examination can largely aid in diagnosis e.g. state of nutrition, arterial disease, neuropathy
• investigations:
• FBC to exclude anaemia
• dipstix urine to exclude diabetes mellitus
• albumin; index of nutrition
• biopsy edge of ulcer if suspicion of malignancy or aetiology is still unknown; can be done at endoscopy for gastrointestinal lesions. No indication that biopsy increases the risk of spread.
• radiology: if suspicion of spread of infection from deeper focus
• correct dressings, frequently changed. Not applicable to gastrointestinal ulcers.
• ensure adequate drainage and desloughing:
• slough inhibits the functioning of granulation tissue
• drainage should be encouraged by surgical or chemical desloughing of ulcer base
• antibiotics are only indicated for infected ulcers in which:
• there is evidence of spread around the margin e.g. a cellulitic rim
• there may be ongoing systemic infection e.g. syphilis, tuberculosis
• correction of specific abnormalities e.g.:
• malnutrition
• myxoedema
• excessive steroid use
• for large deficits or prolonged ulcers with little evidence of healing, further surgical intervention may be indicated e.g. skin grafts and rotational flaps.