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General management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The specific treatment of an ulcer is dependent on the subtype; there are several steps which may be applicable to all ulcers:

  • determination of aetiology:
    • accurate description can aid diagnosis - see submenu
    • complete physical examination can largely aid in diagnosis e.g. state of nutrition, arterial disease, neuropathy
    • investigations:
      • FBC to exclude anaemia
      • dipstix urine to exclude diabetes mellitus
      • albumin; index of nutrition
      • biopsy edge of ulcer if suspicion of malignancy or aetiology is still unknown; can be done at endoscopy for gastrointestinal lesions. No indication that biopsy increases the risk of spread.
      • radiology: if suspicion of spread of infection from deeper focus
  • correct dressings, frequently changed. Not applicable to gastrointestinal ulcers.
  • ensure adequate drainage and desloughing:
    • slough inhibits the functioning of granulation tissue
    • drainage should be encouraged by surgical or chemical desloughing of ulcer base
  • antibiotics are only indicated for infected ulcers in which:
    • there is evidence of spread around the margin e.g. a cellulitic rim
    • there may be ongoing systemic infection e.g. syphilis, tuberculosis
  • correction of specific abnormalities e.g.:
    • malnutrition
    • myxoedema
    • excessive steroid use
  • for large deficits or prolonged ulcers with little evidence of healing, further surgical intervention may be indicated e.g. skin grafts and rotational flaps.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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