Superficial loss of surface tissue as a result of death of the cells is called an ulceration. A simple ulcer, such as the kind found in a small, superficial, partial-thickness burn, tends to heal by granu-lation (ie, new tissue granules) if kept clean and protected from injury. If it is exposed to the air, the serum that escapes will dry and form a scab, under which the epithelial cells will grow and cover the surface completely. Certain diseases cause characteris-tic ulcers; tuberculous ulcers and syphilitic ulcers are examples.
Ulcers related to problems with arterial circulation are seen in patients with peripheral vascular disease, arteriosclerosis, Raynaud‚Äôs disease, and frostbite. In these patients, treatment of the ulcers is concurrent with treatment of the arterial disease. Nursing management includes the use of the dressings discussed at the beginning. If nursing interventions are in-stituted early in the progression of an ulcer, the condition can often be effectively improved. Surgical amputation of an affected limb is a last resort.
Pressure ulcers involve breakdown of the skin due to prolonged pressure and insufficient blood supply, usually at bony promi-nences.