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10. Medical and minor surgical procedures
Leg ulcers
– L eg ulcers are ch ro nic lo sses o f cutaneo us tissue. T h ey are co m m o n in tro p ical
regio ns, resulting fro m varied aetio lo gies:
• vascular: veno us and / o r arterial insufficiency
• bacterial: lep ro sy , B uruli ulcer ( Mycobacterium ulcerans), p haged enic ulcer, y aws,
sy p hilis
• p arasitic: d racunculiasis (G uinea-wo rm d isease), leishm aniasis
• m etabo lic: d iabetes
• traum atic: traum a is o ften a p recip itating facto r co m bined with ano ther und erly ing
cause
– T h e h isto ry o f the d isease and a co m p lete clinical exam inatio n ( p ay ing p articular
attentio n to th e neuro lo gical exam inatio n to d eterm ine if th ere is a p erip h eral
neuro p athy caused by lep ro sy o r d iabetes) usually lead s to an aetio lo gical d iagno sis.
– A ll ulcers m ay beco m e co m p licated with either lo cal o r regio nal seco nd ary infectio ns
( abscess, ly m p h ad eno p ath y , ad enitis, o steo m y elitis, ery sip ela, p y o d erm itis) ,
generalised infectio n (sep ticaem ia), tetanus and after m any y ears o f evo lutio n, sk in
cancer.
Daily local treatment
– B athe the leg fo r 1 0 to 1 5 m inutes in NaDCC o r chloramine and rinse in bo iled water.
– Rem o ve any necro tic ( black ) and fibrino us ( y ello wish) tissue using co m p resses o r
excise the tissue with a scalp el.
– A p p ly :
• to a clean ulcer, with little d ischarge: 10% polyvidone iodine and vaseline;
• to a d irty ulcer, with little d ischarge: silver sulfadiazine;
• to an o o z ing ulcer: 10% polyvidone iodine alo ne;
• to m ultip le o r extensive ulcers with no d isch arge: silver sulfadiazine ( m o nito r fo r
sy stem ic ad verse effects);
• to m ultip le o r extensive o o z ing ulcers: d iluted polyvidone iodine ( 1 / 4 o f
1 0 % p o ly vid o ne + 3 / 4 o f 0 .9 % N aC l o r clean water) fo r o ne m inute then rinse wi
0 .9 % N aC l o r clean water to red uce the risk o f transcutaneo us io d ine abso rp tio n.
– C o ver with a d ry sterile d ressing.
Systemic treatment
– T reatm ent with analgesics in th e event o f p ain: ad ap t the level and d o sage to th e
ind ivid ual (see Pain, p age 2 9 ).
– G ive sy stem ic antibio tics in case o f:
• seco nd ary infectio n (see Bacterial skin infections, p age 1 0 5 ).
281
Leg ulcers
– L eg ulcers are ch ro nic lo sses o f cutaneo us tissue. T h ey are co m m o n in tro p ical
regio ns, resulting fro m varied aetio lo gies:
• vascular: veno us and / o r arterial insufficiency
• bacterial: lep ro sy , B uruli ulcer ( Mycobacterium ulcerans), p haged enic ulcer, y aws,
sy p hilis
• p arasitic: d racunculiasis (G uinea-wo rm d isease), leishm aniasis
• m etabo lic: d iabetes
• traum atic: traum a is o ften a p recip itating facto r co m bined with ano ther und erly ing
cause
– T h e h isto ry o f the d isease and a co m p lete clinical exam inatio n ( p ay ing p articular
attentio n to th e neuro lo gical exam inatio n to d eterm ine if th ere is a p erip h eral
neuro p athy caused by lep ro sy o r d iabetes) usually lead s to an aetio lo gical d iagno sis.
– A ll ulcers m ay beco m e co m p licated with either lo cal o r regio nal seco nd ary infectio ns
( abscess, ly m p h ad eno p ath y , ad enitis, o steo m y elitis, ery sip ela, p y o d erm itis) ,
generalised infectio n (sep ticaem ia), tetanus and after m any y ears o f evo lutio n, sk in
cancer.
Daily local treatment
– B athe the leg fo r 1 0 to 1 5 m inutes in NaDCC o r chloramine and rinse in bo iled water.
– Rem o ve any necro tic ( black ) and fibrino us ( y ello wish) tissue using co m p resses o r
excise the tissue with a scalp el.
– A p p ly :
• to a clean ulcer, with little d ischarge: 10% polyvidone iodine and vaseline;
• to a d irty ulcer, with little d ischarge: silver sulfadiazine;
• to an o o z ing ulcer: 10% polyvidone iodine alo ne;
• to m ultip le o r extensive ulcers with no d isch arge: silver sulfadiazine ( m o nito r fo r
sy stem ic ad verse effects);
• to m ultip le o r extensive o o z ing ulcers: d iluted polyvidone iodine ( 1 / 4 o f
1 0 % p o ly vid o ne + 3 / 4 o f 0 .9 % N aC l o r clean water) fo r o ne m inute then rinse wi
0 .9 % N aC l o r clean water to red uce the risk o f transcutaneo us io d ine abso rp tio n.
– C o ver with a d ry sterile d ressing.
Systemic treatment
– T reatm ent with analgesics in th e event o f p ain: ad ap t the level and d o sage to th e
ind ivid ual (see Pain, p age 2 9 ).
– G ive sy stem ic antibio tics in case o f:
• seco nd ary infectio n (see Bacterial skin infections, p age 1 0 5 ).
281
