Types of ulcer edges ■

▪︎Sloping edge : healing, traumatic and ischaemic venous ulcers.

▪︎Undermined edge : TB

▪︎Punched-out edge : ischaemic and syphilitic ulcers

▪︎Rolled edge : basal cell carcinoma

▪︎Everted edge : squamous cell carcinoma and the ulcerated adenocarcinoma.

#Ulcer
#Surgery_rotation
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🔴Diabetic Foot

▪︎It's Any Pathology Affect Lower Limbs (Specially Foot) That Results Directly From The Chronic Complications Of Diabetes Mellitus


▪︎Pathologies Affect Foot Could Be :
📍1. Infections
📍2. Ulcerations
📍3. Deep Tissue Destruction
📍4. Peripheral Vascular Disease
📍5. Neurological Abnormalities


▪︎Diabetic Foot Responsible For 40-60% Of Non-Traumatic Foot Amputation (Most Amputations Proceeded By Foot Ulcer)

▪︎Foot Ulcer is The Most Important Complications Of Diabetic Foot

▪︎15% Of Diabetic Patients Will Develop Foot Ulcers


🔷Pathophysiology For The Development Of Diabetic Foot
📍1. Peripheral Vascular Disease :
▪︎Chronic Elevation in Blood Sugar Levels Results in Arterial Atherosclerosis

▪︎This Will Results in Reduction Of The Blood Supply To The Foot


📍2. Neurological Dysfunction (Diabetic Neuropathy Most Common Long Term Diabetic Complication) :
🔻I. Sensory Neuropathy :
▪︎Decrease Superficial & Deep Sensations Of The Foot

▪︎Results in Recurrent Undiscovered Foot Trauma & Callus Formation


🔻II. Motor Neuropathy :
▪︎Alterations in The Biomechanics Of The Foot (Muscle Wasting/Ligaments Weakness/Bone Erosions)

▪︎Results in Foot Deformity & Unequal Pressure Distribution On The Foot That Contribute To More Foot Trauma (Metatarsal Head Exposure)


🔻III. Autonomic Neuropathy :
▪︎Decrease Skin Foot Sweating & Abnormal Blood Flow To The Foot (Veins Dilatation Due To AV Shunts)

▪︎Results in Skin Foot Fissuring/Warm Foot/OsteoPenia/Bone Collapse


📍3. Final Results On The Foot (Complications Of Diabetic Foot) :
🔻I. Symptomatic Foot :
▪︎Paraesthesia/Numbness
▪︎Claudication
▪︎Pain

🔻II. Decrease Healing Of Foot Wounds (Diabetic Or NeuroTrophic Or NeuroPathic Ulcers) نفس الاسم

🔻III. Recurrent Foot Infections & Abscess Formation

🔻IV. Progressive Foot Deformity & Joints Destruction (Charcot's Foot NeuroArthroPathy)

🔻V. Foot OsteoMyelitis & Cellulitis

🔻VI. Foot Or Toes Amputation Due To Gangrene (Necrosis)


🔷Risk Factors For Diabetic Foot Ulcers (High Risk Foot)
📍1. Poor Glycemic Control

📍2. Elderly & Blind People (Or Low Vision) & Uneducated

📍3. Obesity & High Alcohol Intake

📍4. Past Hx Of Foot Ulcers

📍5. Diabetic Neuropathy & Peripheral Vascular Disease

📍6. Foot Deformity (Callus/Claw Foot/Hallux Valgus/High Arched/Hammer Toes)


🔷Evaluation Of Diabetic Foot
📍1. Patient Hx To Detect :
▪︎Any Risk Factors Present For Diabetic Foot

▪︎General Medical Condition


📍2. Foot Examination :
🔻I. Ulcer Exam (Size/Shape/Number/Edge/Floor/Base/Temperature/Tenderness/Discharge/Surrounding Skin)

🔻II. Neurological Exam (Sensation/Motor/Autonomic)

🔻III. Vascular Exam (Peripheral Pulses/Skin Temperature & Color/Capillary Refill)

🔻IV. Identify Any Foot Deformity

🔻V. Special Tests (Imaging/Doppler/Angiography/Ankle Brachial Index/Electrophysiological Test)


📍3. Classification Of Diabetic Foot (Wagner Classification) :
▪︎Grade 0 ➡ Intact Skin (But Impending Ulcer Due To Presence Of Risk Factors)

▪︎Grade I ➡ Superficial Ulcer (Partial Or Full-Thickness & No Infection)

▪︎Grade II ➡ Deep Ulcer Extending To Underlying Tissue (But No Bone Involvement)

▪︎Grade III ➡ Deep Ulcer With Abscess & Bone Involvement (OsteoMyelitis)

▪︎Grade IV ➡ Limited Foot Gangrene (Only ForeFoot Or Heel Or Toes)

▪︎Grade V ➡ All Foot Gangrene

#Diabetic_Foot_ulcer
#Surgery_rotation
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🔷Mx Of Diabetic Foot
📍1. Patient Education (Grade 0) :
▪︎No Bare Walking لا تمشي حافي
▪︎No Corn Or Callus Removal
▪︎Attention To Hot Water
▪︎Use Creams For Foot Moisture
▪︎Wear Comfort Shoes
▪︎Stop Alcohol & Smoking
▪︎Glycemic Control

📍2. Reduce Mechanical Factors (Grade I) By Using :
▪︎Walking Aids
▪︎Medical Shoes
▪︎Walking Plaster Casts
▪︎Correction Of Foot Or Bony Deformities


📍3. Reduce Metabolic Factors (For All Grades Mx Of Hypertension/Hyperglycemia/HyperLipidemia/Anemia/Vitamins Deficiency)


📍4. Wound Control (Grade ≥2) :
🔻I. Culture & Sensitivity & Antibiotics (3w For Subcutaneous Infection & 12w For OsteoMyelitis)

🔻II. Foot Xray (To Detect Gas in Deep Tissue/Foreign Body/Bony Erosions/Joint Deformity)

🔻III. Wound Care :
▪︎Necrotic Tissue Debridement
▪︎Daily Dressing & Cleaning
▪︎Hyperbaric Oxygen Therapy
▪︎Platelet Derived Growth Factors
▪︎Skin Graft Or Flap To Close Defect
▪︎Infected Bone Excision (Grade III)


📍5. Amputation :

🔻I. Indications For Amputation :
▪︎Grade 4-5 Diabetic Foot

▪︎Severe Infection (Deep Tissue Necrotizing Infection/Deep Abscess/Uncontrolled Sepsis)

▪︎Tissue Gangrene

▪︎Non-Ambulatory Patient المريض اصلا مقعد

▪︎Inability To Obtain Planter Grade For Weight Bearing
يعني القدم منتهية صلاحيتها وماعاد يقدر يمشي عليها

🔻II. Types Of Amputation :
▪︎Partial Foot Amputation
▪︎Below Knee Amputation
▪︎Above Knee Amputation

#Diabetic_Foot_ulcer
#Surgery_rotation
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❇️ The stoma

▪︎is an artificial opening made in the colon or small intestine to divert faeces and flatus out-side the abdomen where they can be collected in an external Bag.

▪︎stoma may be temporary or permanent / End or loop

▪︎Colostomy: from the large bowel.
▪︎Ileostomy: from the small bowel.


🔹Indications of stoma (p1)

▪︎Permanent end-colostomy: abdominoperineal resection of large rectal cancers leading to the removal of the entire rectum.

▪︎Temporary end-colostomy: allow the distal bowel to rest in the Cases of acute diverticulitis or obstruction.

▪︎Temporary Loop colostomy: protect distal anastomoses after recent surgery.

#Stoma
#Surgery_rotation
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■❇️Stoma Types & Complications

🔹Indications of stoma (P2)

▪︎Permanent End ileostomy: after a panproctocolectomy (rectum & colon removal) for conditions such as ulcerative colitis or familial adenomatous polyposis.

▪︎Temporary End-ileostomy: during emergency bowel resection where it is considered unsafe to form an anastomosis with the remaining bowel at that time (e.g. intra-abdominal sepsis or bleeding).

▪︎Temporary loop ileostomy: protect distal anastomoses after recent surgery.


🔹Comparison

●Ileostomy:
•Spout Present (عنق)
•Fluid content
•In right iliac fossa
•Develop fluid & Electrolyte imbalance

●Colostomy:
•No Spout
•Solid content
•In left iliac fossa

#Stoma
#Surgery_rotation
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Stoma Examination ■

▪︎Begin by inspecting the stoma

noting :
●The site (Right/Left Iliac fossa)
●the number of lumens (1 End/2 Loop)
●the presence or absence of a spout (Neck)
●the contents of the effluent (Solid/Fluid)

▪︎Inspect the surrounding skin for erythema, tissue breakdown، Hernia, fistulation

▪︎Spout present: ileostomy
(مخرج الستومة مرتفع عن الجلد زي العنق )

▪︎Spout absent: colostomy
(مخرج الستومة مع الجلد مافيش عنق)
#Stoma
#Surgery_rotation
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🔴Scrotal swelling

🔹Painful
▪︎Testicular torsion
▪︎incarcerated Inguinal hernia
▪︎Epididym orchitis
▪︎Torsion of appendix testis (Blue Dots Sign)
▪︎Truma

🔹Painless
▪︎Hydrocele
▪︎Spermatocele
▪︎Varicocele
▪︎Reducible Inguinal hernia
▪︎Testicular tumor

🔹Emergent
▪︎testicular torsion
▪︎Necrotizing fasciitis (Fournier’s gangrene)
▪︎Trauma
▪︎Epididym orchitis


▪︎Mostly In Left Side ➡️ Varicocele
▪︎Mostly in Right Side ➡️ Undescended Testis/Testicular Tumor/Inguinal Hernia

▪︎+Ve Transillumination
•Hydrocele ➡️ Testis Not Palpable
•Spermatocele ➡️ Testis Are Palpable

▪︎Scrotal Elevation Relief The Pain (+Ve Prehn's Sign) ➡️ Epididmyitis/Orchitis

▪︎Scrotal Elevation Not Relief The Pain (-Ve Prehn's Sign) ➡️ Testicular Torsion

▪︎-Ve (Absent) Cremasteric Reflex ➡️ Testicular Torsion

#Surgery_rotation
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🔴Hydrocele

▪︎Abnormal Serous Fluid collection in the Scrotum

🔹Causes
▪︎Primary (Congenital-Communicating)
•Infantile
•Congenital
•Encysted
•Vaginal

▪︎Secondary (Non Communicating)
•Truma/Tumor
•EpididymoOrchitis
•Lymphatic Obstruction
•After Varicocelectomy

🔹Tx
▪︎In Children
•May Resolve in 1st 2 Years of life
•Herniotomy

▪︎In Adults : Surgical Excision

🔴Undescended Testis

🔹Most Common Sites For Testis
•External Inguinal Ring
•Inguinal Canal
•Abdomen (Testis Not Palpable)

🔹Complications
•Infertility (More in Intra abdominal Testis)
•Pain (By Truma or Torsion)
•Epidymorchitis
•Cancer
•Indirect Inguinal Hernia

🔹Tx
1. Palpable
▪︎Orchidopexy (moves undescended Testis into the scrotum & Fixation)

▪︎Orchidolysis (correction of the undescended Testis without fixation)

2. Non Palpable
▪︎Inguinal Surgical Exploration
▪︎Laparoscopy

🔰Time of Correction Of
▪︎Hernia ➡️ Within 1 Month
▪︎Undescended Testis ➡️ Within 1 Year
▪︎Hydrocele ➡️ Within 2 Years


https://t.me/Surgery_Practice

🔴Varicocele

▪︎abnormal enlargement and Tortuous of the pampiniform venous plexus in the scrotum

🔹Features
1.More in Left Side (Higher & More perpendicular Course of Left Testicular Vein)

2.Painless

3.Palpation feels like bag of Warms

4.Pulsates with Valsalva (Increase Intra abdominal pressure)

5.Cause Infertility (Due to High Scrotal Temperature)

6.Cause Testicular Atrophy

7.Affected Side Will be Lower than Normal

🔹Aetiology
1.Incompetent Venous Valves (Congenital)

2.Prolong Standing

3.Chronic Increase in Intra Abdominal Pressure (Like Chronic Pulmonary Disease)

4.Nut Cracker Phenomenon (Left Renal V entrapment Between Aorta & Superior Mesenteric A)

🔹Dx ➡️ Doppler US

🔹Tx
▪︎Varicocelectomy (Ligation Or Occlusion of Internal Spermatic Veins)

▪︎Indications Of Tx
1.Infertility (Impaired Sperm Quality Or Quantity)
2.Pain
3.Testis Fail to Grow

▪︎Complications of Tx
1.Recurrence
2.Hydrocele
3.Testicular Infarction (Injury of Testicular A)

#Surgery_rotation
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🔰Foley Catheter

🔹1-Way urinary catheters
▪︎have only one channel for passage of urine.
Like CIC (clean intermittent catheterization)


🔹2-Way urinary catheters
▪︎The most Commonly Used

▪︎Have two channels: one channel is for the passage of urine and the other for balloon inflation and deflation.


🔹3-Way urinary catheters
▪︎available with a third channel to facilitate continuous bladder irrigation

▪︎primarily used After urological surgery or in case of bleeding from a bladder or prostate, For continuous or intermittent irrigation to clear blood clots or debris.

🔹Duration
▪︎7-10 days for latex
▪︎1 month for the silicon

🔹Alternative way
▪︎suprapubic cystostomy

▪︎Catheter Length 40-45 cm

▪︎Recommended Use The Smallest Size

▪︎Most Common Materials ➡️ Silicon/Silicon Coated Latex

▪︎Size Measurement By French (1FR=3mm)

#Surgery_rotation
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🔰Foley Catheter

🔹indications of use :

▪︎one way :-
-in CIC (clean intermittent catheterization)

▪︎two way :-
○Diagnostic :
•Urine collection (measurements Of Urine Output & residual volume)

○therapeutic :
•Relive Acute urinary retention
•During Urologic & Contiguous Surgery (To Prevent Urine leakage by accident)

▪︎three way :-
•Bladder Irrigation After Bleeding (Clots Present)
•injection Of AB & Chemotherapy & Contrast
•Urodynamic and Cystography

🔹Long Term Catheterization For
1. Refractory urine retention (not correctable)
2. Neurogenic bladder
3. Incontinence

🔹Contraindications
1. Suspected Urethral injury
2. Urethral Strictures
3. Urethral Sepsis
4. High Riding Or Detached Prostate
5. Difficult Insertion For Other Reasons

🔹Complications
1. Inability to catheterize
2. Infection
3. Urethral injury/Stricture
4. Psychological trauma
5. Paraphimosis
6. Hematuria
7. Stone Formation
8. Allergy or sensitivity to latex
9. Bladder cancer (After long-term Use)

https://t.me/Surgery_Practice