cysts , ulcers and sinuses

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CYSTS , ULCERS AND SINUSES

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• 1. ??????????????????????????? TRUE ??? FALSE
  CYSTS
• ????????????????????????????? ULCER
• 3. ??????????????????????????? SINUSES ???
  FISTULA ?????????????????????? SINUS ????????? ?

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CYSTS

• ? KUSTIS
• ? TRUE AND FALSE CYSTS
• EPITHELIAL LINING
• ? CONGENITAL OR ACQUIRED

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CYST CLINICAL FEATURES

• ? DEPEND ON SITE AND SIZE
• ? PAIN ENLARGING (HEMORRHAGE
  OR INFECTION )
• ? SUPERFICIAL , DEEP SEATED
• TRANSILLUMINATION
• ? COMPLICATION INFECTION ,HEMORRHAGE
• TORSION , OBSTRUCTION, CALCIFICATION

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ULCER

• ? BREAKING OF CONTINUITY OF EPITHELIAL SURFACE
• ? DESTRUCTION OF EPITHELIUM AND GRANULATING
• BASE
• ? NON SPECIFIC , SPECIFIC , MALIGNANT
• ? ACUTE INFLAMMATION , CHRONIC INFLAMMATION
• ? DELAYED EPITHELIAL HEALING ( ISCHEMIC
• INFECTION)
• ? INDURATED ULCER
  
• 
  ? NEUROPATHIC ULCERS
• DEEP BASE c SHARPLY CUT EDGE

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ULCER CLINICAL FEATURES

• 1. SITE 6. BASE
• 2. SIZE 7. DISCHARGE
• 3. SHAPE 8. LYMPH NODE
• 4. EDGE 9. PAIN
• 5. FLOOR

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ULCER

• GENERAL EXAMINTION SIGNS
• PATHOLOGICAL EXAMINATION BIOPSY , SEROLOGICAL
  TEST
• MARJOLIN S ULCER CARCINOMATOUS CHANGE AT
  THE EDGE OF
• CHRONIC VENOUS ULCER , ANY
  LONG STANDING
• BENIGN ULCER

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MANAGEMENT ULCER

• ? ETIOLOGY ( HX , PE , BIOPSY )
• ? TREAT UNDERLYING INFECTION , VENOUS OR ART
  INSUFFICIENCY , DM
• ? ADEQUATE DRAINAGE , DESLOUGHING
• EXCISION DEAD TISSUE

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MANAGEMENT ULCER ( CONT )

• ? NEW TISSUE COVERAGE SKIN GRAFT , FLAP
• ? ANTIBIOTIC ( INFECTED , CELLUKITIC TISSUE )
• ? CLEANING WITH NSS
• ? IDEAL DRESSING SOFT , ABSORBENT ,
• NON-ADHERENT, NON ALLERGIC
• HYDROCOLLOID GELS ? LEG ULCER ,
  PRESSURE SURE
• ALGINATES ? MODERTE TO HEAVY
  EXUDATES
• MICROPOROUS POLY URETHANE FILM ?
  SHALLOW LESION

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SINUSES

• ? BLIND ENDING TRACT WITH GRANULATION
  
• TISSUE
• ? CONGENITAL OR ACQUIRED ( FB , INFECTION
• NECROTIC MATERIAL )
• ? FISTULA TWO END EPITHELIUM LINED
  SURFACE

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CLINICAL FEATURES SINUS

• ? ASYMPTOMATIC
• ? RECURRENT OR PERSISTENT DISCHARGE
• ? PAIN
• ? MICROORGAMSM INFECTION BACTERIA
• ACTINOMYCOSIS , TB
• ? SINOGRAM IDENTIFY TRACT , HYPAQUE

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MANAGEMENT SINUS

• ? DEFINITIVE REMOVAL CAUSE
• ? EXCISION FOR DIAGNOSIS AND
• TREATMENT

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COMMON ACQUIRED SINUSES

• POST SURGICAL ABDOMINAL AND PERINEAL SINUSES
• - SUTURE SINUS REMOUAL OF SUTURE
• - INTRAABDOMINAL ABSCESS OR ANASTOMUTIC
  LEAKS DRAINAGE
• LOCALIZED ABSCESS
• PERINEAL SINUS
• - POST PROCTOCOLECTOMY ESP. FOR CROHN S
  DISEASE
• - OPENING AND DECORTICATION OF CAVITY

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• PILONIDAL SINUS
• - LOOSE HAIR SHAFTS , FORCED INTO DEEP
  TISSUE
• BY GLUTEAL CONTRACTION
• - SINUS TRACT
• - ADEQUATE EXCISION
• - RECURRENCE ? 40
• HYDRADENITIS SUPPURATIVA
• - APOCRINE SWEAT GL. ABNORMALITY
• - AXILLA , GROIN , PERINEUM , AROUND NIPPLE
• - RECURRENT ABSCESS AFTER PUBERTY
• - TETRACYCLINE , RADICAL SURGICAL EXCISION

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CONGENITAL SINUSES

• 1. PREAURICULAR SINUS
• ? ASYMPTOSNATIC
• ? INFECTED
• ? INCISION AND DRAINAGE , EXCISION
• 2. UMBILICAL SINUS
• ? CONTINUED PRESENT OF UMBILICAL END OF
  VITELLINE DUCT
• ? PERSIST IN PART OR ENTIRETY
• ? EXCISION

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• 3. URACHAL SINUS
• ? CONNECT BLADDER TO UMBILICUS
• ? PERSISTENT , INFECTED
• ? EXCISION