In some cases, healing goes on more rapidly under a dressing of weak boracic ointment (one-quarter the strength of the pharmacopœial preparation). The growth of epithelium may be stimulated by a 6 to 8 per cent. ointment of scarlet-red.
Dusting powders and poultice dressings are best avoided in the treatment of healing sores.
In extensive ulcers resulting from recent burns, if the granulations are healthy and aseptic, skin-grafts may safely be placed on them directly. If, however, their asepticity cannot be relied upon, it is necessary to scrape away the superficial layer of the granulations, the young fibrous tissue underneath being conserved, as it is sufficiently vascular to nourish the grafts placed on it.
Treatment of Special Varieties of Ulcers.—Before beginning to treat a given ulcer, two questions have to be answered—first, What are the causative conditions present? and second, In what condition do I find the ulcer?—in other words, In what particulars does it differ from a healthy healing sore?
If the cause is a local one, it must be removed; if a constitutional one, means must be taken to counteract it. This done, the condition of the ulcer must be so modified as to bring it into the state of a healing sore, after which it will be managed on the lines already laid down.
Treatment in relation to the Cause of the Ulcer.—Traumatic Group.—The prophylaxis of these ulcers consists in excluding bacteria, by cleansing crushed or bruised parts, and applying sterilised dressings and properly adjusted splints. If there is reason to fear that the disinfection has not been complete, a Bier's constricting bandage should be applied for some hours each day. These measures will often prevent a grossly injured portion of skin dying, and will ensure asepticity should it do so. In the event of the skin giving way, the same form of dressing should be continued till the slough has separated and a healthy granulating surface is formed. The protective dressing appropriate to a healing sore is then substituted. Pressure sores are treated on the same lines.
The treatment of ulcers caused by burns and scalds will be described later.
In ulcers of the leg due to interference with the venous return, the primary indication is to elevate the limb in order to facilitate the flow of the blood in the veins, and so admit of fresh blood reaching the part. The limb may be placed on pillows, or the foot of the bed raised on blocks, so that the ulcer lies on a higher level than the heart. Should varicose veins be present, the question of operative treatment must be considered.
When an imperfect nerve supply is the main factor underlying ulcer formation, prophylaxis is the chief consideration. In patients suffering from spinal injuries or diseases, cerebral paralysis, or affections of the peripheral nerves, all sources of irritation, such as ill-fitting splints, tight bandages, moist applications, and hot bottles, should be avoided. Any part liable to pressure, from the position of the patient or otherwise, must be carefully protected by pads of wool, air-cushions, or water-bags, and must be kept absolutely dry. The skin should be hardened by daily applications of methylated spirit.
Should an ulcer form in spite of these precautions, the mildest antiseptics must be employed for bathing and dressing it, and as far as possible all dressings should be dry.