Skin ulcer is a common and frequently-occurring disease in traditional Chinese medicine surgery. It is a clinical disease characterized by skin ulcers as the main clinical manifestation of long-term inability to heal. Skin tissue defects are liquefied and infected with necrosis. This is a general term for TCM surgical sores. Long unhealed. Because the sore surface is difficult to heal and consumes a lot, it causes great psychological stress and economic loss to the patient, which seriously affects the patient's physical health and quality of life.
Etiology and pathology of skin ulcers
Skin ulcer
Skin ulcers are generally localized skin defects caused by trauma microorganisms, tumor circulation disorders and neurological disorders, immune dysfunction, or congenital skin defects. Traumatic ulcers are often caused by physical and chemical factors that directly affect tissues and cause microbial infectious diseases. Vascular inflammatory ulcers caused by bacterial fungal Borrelia virus and other tissue destruction nodules or tumor rupture caused by arterial or arteritis necrosis of tissues to form circulation or neurological dysfunction belong to nutritional disorders causing tissue necrosis such as varicose veins Leprosy ulcers, etc.
In order to facilitate the management of medical records in clinic, pathological damage is divided into three types:
Skin ulcer type I
: The depth range of the ulcer is only the skin, which is called simple refractory skin ulcer, abbreviated as sheet type;
Skin ulcer type II
: The scope and depth of ulcers Design skin, muscles, tendons, ligaments, nerves, blood vessels, bones, etc., known as refractory skin ulcers in existing buildings, referred to as bowl type.
Skin ulcer type III
: The scope and depth of the ulcer are the same as type , except that the length of the damage range far exceeds the width, which is called a blind duct-like deep skin ulcer, referred to as sinus type.
Clinical manifestations of skin ulcers
First, varicose ulcers are circular or irregular in shape, and the edges are hard and slope-like; the cavity is shallow, the base is uneven, and there are purulent components. ?
Second, structural ulcers are irregular jagged, sneaking at the edges, pale at the bottom, with pale yellow thin purulent secretions, and less odorous. ?
Skin ulcer
Third, pressure ulcer bedsores are the most common, and they occur in the cercariae, sacrum and ankle. The ulcer is round, the edges are rigid and tough, and it is funnel-shaped. The granulation tissue on the wound is loose, the secretion is thin, and there is a foul odor.
Fourth, malignant ulcers are irregularly shaped, the edges are raised, the valgus is cauliflower-shaped, the base is uneven, easy to bleed, and the secretions are stinky.
According to clinical practice observations, chronic skin ulcers have the following characteristics:
Ulcers are mostly located in dense connective tissue and relatively poor blood flow, such as anterior tibia, ankle and foot. There were 86 cases in this group, accounting for 71.07% of the total.
The reasons are mostly severe local soft tissue damage, severe local scarring or improper early treatment, even with bone scars, poor blood circulation, such as heavy pollution and incomplete debridement.
The patients are mostly elderly, and the ulcer itself often does not affect their lives, so the patients and their families have not attracted enough attention and lacked formal and systematic treatment. The average age of this group of patients was 71 years, and most of them came to the clinic because of eczema and severe itching of the skin.
Combined exposure of bones, joints, steel plates, tendons, etc., cannot be solved with non-surgical treatment such as dressing change.
Skin ulcers adjacent to joints, chronic chronic inflammation, can cause joint stiffness and stiffness, and even inflammation spread to the joints, forming septic arthritis, increasing the difficulty of treatment.
Longer course, poor general condition or other complications. The combination includes 62 cases of lower extremity varicose veins, 35 cases of diabetes, 65 cases of heart disease and hypertension, and 81 cases of anemia or hypoproteinemia. Due to the existence of these diseases, the healing or treatment effect of ulcer is seriously affected.
Diagnosis of skin ulcers
History of skin ulcers
Understanding the history of ulcer patients should be based on the cause of ulcers. Generally speaking, the age, sex, occupation, and history of unclean sexual intercourse should be included. Because ulcers are often secondary damages, it is important to understand the characteristics of the initial lesions in the current medical history. To provide diagnostic clues, you should also understand how fast the skin lesions develop, the duration of the disease, and the medication history.
Physical examination of skin ulcers
Physical examination should pay attention to the patient's general condition and the size of the ulcers. The color of the edges is clear or not. The shape of the base and surface secretions, etc.
Skin ulcer laboratory test
Histopathology is a commonly used diagnostic method. Tumor vasculitis and general inflammatory ulcers can be differentiated. Bacterial culture and fungal examination are helpful for the diagnosis of infectious diseases. See the differential diagnosis for details.
Skin ulcer hazard
1. Chronic skin ulcers are caused by trauma, crush injury, skin trauma, etc. that directly hurt the human body, and then feel the poisonous evil, causing abnormal blood and blood operation, leading to skin ulcers, but cannot protect the skin or stay away from the stimulating environment, and will not heal for a long time , Serious harm to patients' health and quality of life.
2. Skin ulcers are the main clinical manifestations of long-term non-healing as a clinical feature. Skin tissue defects are liquefied and infected with necrosis. Because the sore surface is difficult to heal and consumes a lot, it causes great psychological stress and economic loss to the patient, which seriously affects the patient's physical health and quality of life.
3. Improper treatment is easy to form old rotten legs, diabetic foot, ulcerative gangrene, purulent osteomyelitis, purulent infection of skin and soft tissues, thin secretions, foul odor, patients will not heal for years, and suffer torture.
Skin ulcer treatment
1. For the cause of treatment: such as allergic (drug rash) to cut off the allergen; diabetic foot, pay attention to blood glucose control; physical and chemical damage, pay attention to stay away from the cause of the disease; occupational diseases, try to eliminate the conditions Wait.
2. Supportive treatment: including good local braking, raising the affected area, good care, etc., pay attention to the balance of water and electrolyte, and give a high protein and high energy and vitamin diet. Improve patient immunity.
3. Drug treatment: anti-allergic drugs, anti-parasite drugs, antibiotics (anti-infection, protection of wounds), and drugs that promote healing of ulcers, etc.
4. Surgical treatment: For malignant or cancerous skin caused by tumors, it should be treated in time.
Local treatment
Debridement and replacement of ulcers; removal of necrotic tissue, scars, old granulation tissue, foreign bodies, etc., to relatively healthy and blood-rich tissues. For patients with exposed chronic ulcers such as bones and joints, which require flap repair, the quality of wound treatment is one of the keys to successful flap transplantation. Soak and rinse with hydrogen peroxide, new clean and extinct, saline, iodophor for 5min. Cover with pividiodic gauze and severe local edema. Wet compress with 3% hypertonic saline, or root culture, test results, and antibiotics and antifungals.
Treatment of skin eczema: fully follow the principles of dermatology topical drugs: during exacerbations, more exudate, apply a 3% boric acid solution for wet compresses, and use a glucocorticoid cream after less exudation; Cream or Hundred State Ointment.
Local physiotherapy: He-Ne laser, ultra-short wave, infrared and other local irradiation.
Surgical treatment: For patients with large ulcers, long-term dressing changes or exposed bones, joints, tendons or steel plates, surgical treatment should be considered. In this group, 72 cases were treated surgically (47 cases were skin graft alone, 25 cases were flap repair), and 49 cases were treated non-surgically.
Systemic treatment
The purpose of systemic treatment is to resist inflammation, itching, and improve the body's resistance.
Application of antibacterial or antifungal drugs, root bladder bacterial and fungal culture and examination results, intravenous application of antibiotics and antifungal drugs;
Application of antihistamines, calcium, vitamin C, etc .;
Drugs that improve the body's resistance: such as Utilinus;
Correct anemia or hypoproteinemia.
Treatment of other concomitant diseases: For patients with varicose veins in the lower limbs, diabetes, heart disease, hypertension, etc., please consult a specialist for regular and systematic treatment.
Four drug treatments
Comfrey oil
100g of comfrey is soaked in sesame oil heated to 60 ° C to 70 ° C, left for 24 hours, and the oil is filtered out and used. Use 75% first
Skin ulcer
The affected surface was disinfected with alcohol (the necrotic tissue was scrubbed with 30% hydrogen peroxide and then rinsed with saline), and then coated with comfrey oil twice daily until healing.
Ruyi golden powder
Adjust the medicinal vinegar into a thin paste and apply it to the affected area twice a day. You can also make Ruyi Golden Powder and Vaseline according to a ratio of 2 to 8 and apply it externally. If there are many ulcers or secretions, wash the wound before using this medicine.
Maying Long Musk Hemorrhoid Cream
Although it is a hemorrhoid medicine, it is very effective for skin ulcers. Method: First disinfect the part with 75% alcohol, wipe dry with a dry cotton swab, apply an appropriate amount of this cream, cover with sterile gauze, and change the medicine once or every other day.
Compound Calamine External Use Powder
After local disinfection, sprinkle this medicine on the affected area 1 to 2 times a day.
Honey for skin ulcers
Honey has high nutritional value. Oral administration can treat and alleviate various gastrointestinal diseases. In terms of surgery and dermatology, the use of honey is not small. Honey contains antibiotic substances, has antibacterial and antiseptic effects, can inhibit the growth of pyogenic fungi and molds, and has astringent, anti-inflammatory, analgesic, muscle growth and accelerate wound healing, skin protection and other effects. Suitable for burns, scalds, frostbite, trauma and leg ulcers, thrush in children, etc. The reason why honey can promote wound healing is that honey contains 40% glucose, 40% fructose and a variety of amino acids, vitamins and trace elements, which has the effect of nourishing wounds. At the same time, honey has hygroscopic and astringent effects, can reduce granulation tissue edema and form a sticky protective barrier, prevent wound infections, bedsores, lower extremity ulcers, etc., can make wounds scab quickly, and epithelial healing is good.
Clinical treatment
You can give mupirocin ointment for external application and apply it to the affected area twice a day. However, in the case of long-term use of antibiotics in western medicine, it will cause dependence on the body, disrupt the microbial balance of the body, and cause damage to liver and kidney function. Therefore, the current treatment of skin ulcers is mostly treated by traditional Chinese medicine, such as: first disinfecting the affected area with 75% alcohol (wash necrotic tissue with 30% hydrogen peroxide, then rinse with saline), and then apply osmium oil daily 2 Or after disinfection, topical compound calamine is sprinkled on the affected area 1 to 2 times a day, and healing is relatively slow.
It is recommended to use gauze-soaked Kangxin solution for external application to the skin ulcer for 2 hours, twice a day. Wetly apply mupirocin ointment to the skin, which has a significant clinical effect. Kangfuxin Liquid is a traditional Chinese medicine preparation. It has antibacterial and anti-inflammatory properties, improves immunity, accelerates wound healing, and shortens wound healing time. It can promote blood vessel proliferation, improve wound microcirculation, enhance granulation growth, and strengthen wound repair. The effect is an ideal drug for the treatment of skin ulcers, especially chronic ulcers. Kangfuxin solution has no adverse reactions, is easy for patients to accept, convenient to use, and has satisfactory treatment results.
Skin ulcer prevention
1. Actively control the primary disease, such as blood glucose control in patients with diabetes.
2. For the damaged environment, protect the skin or stay away from the stimulating environment, such as cold, pay attention to the warmth of the skin, and prevent the occurrence of frostbite.
3. Regular skin care For patients who are bedridden for a long time, pay attention to turning back and patting back, local skin care to prevent the occurrence of bedsores.
4. Early detection and early treatment. Prevent skin cancer.
Differential diagnosis of skin ulcers
Skin ulcer bacterial disease
1. Skin bloated cellulitis: bloated is caused by staphylococcal deep folliculitis and peri-folliculitis. Several are fused with each other to form an inflammatory mass. Cellulitis is caused by staphylococcus hemolytic streptococcus extensively under the skin. Tissue suppurative infection The inflammatory mass of the above three infections can form ulcers after purulent ulcers. Bacterial cultures have pathogenic bacteria that have red and hot pain and other inflammatory characteristics are generally not difficult to distinguish from ulcers.
2. Sweat gland inflammation: Female infections that occur in the area of the sweat glands are more common. They occur mainly in the genital groin outside the axilla and around the anal inflammatory sclerosis.
3 Swollen ulcers: Streptococcus infection is the main cause of unclean trauma insect bites. It mainly occurs in the lower leg. It starts with inflammatory water sores or abscesses. The exudate develops to the periphery and deep. The ulcer realm is clear. The round or oval ulcer has a steep base and a harder gray-green purulent secretion. It usually scars in 2 to 4 weeks, and it can be formed for a few months. A few dozens can be formed for a long time. Necrotizing ulcer.
4 Lupus vulgaris: It is the most common type of skin tuberculosis. It is more common in children and young people. It is common in the face. It is a small nodule. The color of the apple sauce can be broken by itself. It can form an atrophic epilepsy after the ulcer is healed. New skin lesions can be seen around it. Chronic pathology of painless course shows typical tuberculous nodules.
5. Painful skin tuberculosis: most often occur in children and young women. Tuberculosis lesions of the lymph nodes bones and joints under the skin often spread to the skin through the lymph and the disease occurs first. Lymph node tuberculosis is more common in the neck and upper chest, followed by axillary groin. Nodules are hard and hard, and adhesions melt. Synthetic blocks show caseous necrosis softening and rupture to form epidemic tube and ulcer pathology showing tuberculous nodules.
6. Leprosy ulcers: Nutritional ulcers caused by neurological dysfunction in leprosy patients generally occur in the soles of the feet and heels, and the nearby ulcers are chiseled and painless. The dark red granules are stale and are not easy to bleed. The surface has corrupt and necrotic tissues, often accompanied by peripheral superficial nerves. Large, dry skin, no sweat, alopecia, sensory disorders, and other chronic diseases that are difficult to heal can be diagnosed with the help of a biopsy such as a leprosy test.
Skin ulcer fungal disease
1. Sporotrichosis: This disease is often caused by Mycelia spp .; it often occurs when the limbs produce subcutaneous nodules without pain and nodules at the invading area. After expansion, they soften and ulcerate and form ulcers. Spread upward along the lymphatic vessels in a strip-like number, but more or less lymphatic vessels can be enlarged by fungal microscopy or culture. It can help diagnose pathology showing chronic granulomatous changes. Round crocees can be seen in macrophages and sometimes stellates.
2. Cryptococcosis of the skin: Caused by a new type of Cryptococcus, it can start as a soft wart-like or acne-like papular nodule abscess shortly after the central ulceration edge, clear boundaries, no redness, several damages can be merged into larger ulcers, new membranes often have ulcers, damages Fungal cultures that occur in the face, chest, and limbs can help diagnose.
3, histoplasmosis: caused by histoplasma through the respiratory tract, skin and mucous membranes, gastrointestinal infections mainly invade the lung, bone marrow, liver, spleen, and lymph nodes, and other skin and mucous membrane damage begins to be solid, hard plaques, and the suppuration ulcers form painful. The pathology of sexual ulcer shows that the macrophages can be found in phagocytes and tissue cells.
4, Actinomycosis, foot fungus such as Karst disease: is a chronic purulent disease, nodules ruptured after the granules pus can form ulcers fistula fungal examination can distinguish and confirm the diagnosis.
5, yellow ringworm and psoriasis: for fungal infection of the head may have superficial ulcers, fungal microscopic examination culture can establish the diagnosis.
Skin ulcer