Tropica ulcers

Aden ulcer," "Jungle rot," "Malabar ulcer," and

"Tropical phagedena

ULCERS-Gradual and progressive loss in the
continuity epithelial or mucosal lining
TROPICAL ULCERS
A tropical ulcer is an ulcer common in third
world countries commonly in the tropics and it
occurs on the lower extremities of the leg.

Epidemiology
Careful research in Uganda has clarified the etiology. The
ulcers occur at all ages, being recorded from age 5 to
70 years old. In children the sex incidence is equal, but
in adults in most countries they are more common in
men; this reflects the higher probability of trauma to
the male leg. Ninety percent develop below the knee,
affecting the front and outer side of the leg and the
ankle region particularly. . Tropical ulcer has been
described as a disease of the 'poor and hungry', and it
may be that slowly improving socioeconomic
conditions and nutrition account for its decline.
Urbanization of populations is another factor, as
tropical ulcer is usually a rural problem. More
widespread use of shoes and socks also provides
protection from initiating trauma.

MARERA DOMNIC
KAMPALA INTERNATIONAL UNIVERSITY
WESTERN CAMPUS.
GRAND ROUND PRESENTATION HELD ON

JANUARY,13,2011
AT
MAKERERE UNIVERSITY CONFERENCE HALL
ETIOLOGY
FUSIFORM BACTERIA=Vincent's organism
FLY
FRICTION
FOOD








GENERAL PRESENTATION
A small discoloured patch, usually on the lower leg,
develops rapidly over 5-6 days into a pustule of more
than 1cm.
When this ruptures foul smelling blood-stained pus
exudes
Considerable tissue damage is apparent at this stage as
full thickness epidermal tissue has been destroyed to
reveal an ulcer.
The ulcer is regular round/oval in shape, with a sloughy
wound bed and a clearly defined edge. The edge will
not be significantly undermined.
Ulcers are most frequently seen on lower legs but may
occasionally be seen on thighs and arms

Oedema exists around the ulcer along with
hyperpigmentation which can last a significant amount
of time after the ulcer has healed.
Generally there is some growth over the first 2-3 weeks
(the acute phase) and the maximum size is reached at
6 weeks.
Initially, in the acute phase, the wound will be painful.
If the wound does not heal and moves into a chronic
phase it stops being painful.
If the wound is treated promptly in the acute phase it
may heal and not progress to the chronic ulcerative
phase. On some occasions the wounds will heal
spontaneously without treatment however this may
take months or years and leaves a heavy fibrotic scar.

TYPES
Acute tropical ulcer
It has short hx of less than 1 month
It is very painful
It discharges pus
The patient is febrile means systemic infection
On culture and sensitivity of pus specific macro-
organism fuss form bacteria are found
On x-ray there is no sign of bone infection
There is bleeding at times
Foul smelling

Chronic tropical ulcers
Takes more than 1 months
Not painful
There is no discharge or bleeding
No systemic infection
The patient is not febrile
The edges of the ulcer is irregular
The surrounded tissues are
hyperpigmented.

DDX
Diabetic gangrene
marjolins ulcer
Rodent ulcer
Venous ulcers

MANAGEMENT
Treatment of uncomplicated chronic tropical ulcer
comprises three main aspects;
1-control of infection
2-control of any factors hindering healing
3-provision of robust epithelial cover which will protect
against further ulceration and malignant change.
-For control of infection patients require systemic
treatment with antibiotics, chosen on the basis of
laboratory determined sensitivities.
-Excision of indolent granulation tissue, areas of dense
fibrosis, and severely scarred depigmented skin may be
essential to achieve ultimate healing. Contractures and
bone deformity will usually need to be corrected before the
ulcer is covered. Bone infection must be controlled
Epithelial cover is usually achieved by applying
a split-thickness skin graft to the granulating
bed of the ulcer or after excision of the ulcer.
Management of underlying condition leading
to ulceration.

COMPLICATIONS
Septicaemia
Malignancy
Osteomyelitis
Chronic ulcers
Contractures
Gangrene
Pathological fracture
Loss of function