Chronic undermining burrowing ulcer

Chronic Undermining Burrowing Ulcer

A chronic undermining burrowing ulcer is a type of ulcer that is characterized by its tendency to extend under the skin, creating a network of tunnels or "burrows". These ulcers are often difficult to treat due to their complex structure and the underlying causes that contribute to their formation.

Pathophysiology

Chronic undermining burrowing ulcers typically occur when there is prolonged pressure, infection, or inflammation that leads to tissue necrosis. The ulcer begins as a superficial lesion but gradually extends deeper into the subcutaneous tissue. The edges of the ulcer are often undermined, meaning the skin overhangs the ulcer base, and the ulcer can extend into surrounding tissues, creating a burrowing effect.

The most common causes of these ulcers include:

• Pressure ulcers: Often seen in patients with limited mobility, these ulcers form due to prolonged pressure on the skin.
• Diabetic foot ulcers: Resulting from neuropathy and poor circulation in diabetic patients.
• Venous ulcers: Caused by chronic venous insufficiency.
• Infectious diseases: Such as tuberculosis or syphilis, which can cause gummatous lesions that burrow.

Clinical Presentation

Patients with chronic undermining burrowing ulcers may present with:

• Pain or discomfort at the site of the ulcer.
• Foul-smelling discharge if the ulcer is infected.
• Visible undermining of the skin around the ulcer.
• Signs of systemic infection if the ulcer is severe.

Diagnosis

Diagnosis of a chronic undermining burrowing ulcer involves:

• Clinical examination to assess the extent and depth of the ulcer.
• Biopsy of the ulcer edge to rule out malignancy.
• Imaging studies such as MRI or ultrasound to evaluate the extent of tissue involvement.
• Microbiological cultures to identify any infectious organisms.

Treatment

Treatment of chronic undermining burrowing ulcers requires a multidisciplinary approach:

• Wound care: Regular cleaning and debridement to remove necrotic tissue.
• Pressure relief: Use of specialized mattresses or cushions to reduce pressure.
• Infection control: Antibiotics for bacterial infections.
• Surgical intervention: In some cases, surgical debridement or skin grafting may be necessary.
• Management of underlying conditions: Such as optimizing blood glucose levels in diabetic patients or improving venous circulation.

Prognosis

The prognosis for patients with chronic undermining burrowing ulcers depends on the underlying cause and the effectiveness of treatment. Early intervention and comprehensive management can improve outcomes and prevent complications such as osteomyelitis or sepsis.

Also see

• Pressure ulcer
• Diabetic foot ulcer
• Venous ulcer
• Wound healing
• Skin grafting