. American practice of surgery ; a complete system of the science and art of surgery . veins of the inferior extremities,particularly when they involve the smaller cutaneous veins, undoubtedly con-stitute one of the most prominent causes of ulcer; and, furthermore, the vari-cose ulcer stands as the classic type of all ulcers, and the one with which thesurgeon is most familiar. These venous varicosities produce a passive hyper-emia of the skin and subcutaneous tissues, as a result of which these structuresbecome infiltrated with serum and suffer correspondingly from enfeebled nutri-tion. This l
. American practice of surgery ; a complete system of the science and art of surgery . veins of the inferior extremities,particularly when they involve the smaller cutaneous veins, undoubtedly con-stitute one of the most prominent causes of ulcer; and, furthermore, the vari-cose ulcer stands as the classic type of all ulcers, and the one with which thesurgeon is most familiar. These venous varicosities produce a passive hyper-emia of the skin and subcutaneous tissues, as a result of which these structuresbecome infiltrated with serum and suffer correspondingly from enfeebled nutri-tion. This lowered nutrition leads either to a periphlebitis—which results in asmall abscess that opens and leaves an ulcer—or to a local eczema, which read-ily ulcerates. Then, again, the lowered vitality of the skin is such that theslightest traumatism may result in bacterial invasion, inflammation, and ulcera-tion. These ulcers are most commonly situated on the leg near the malleoli, espe-cially the internal, or a short distance above the malleoli. American Peagtige of Surgery Plate XI,. Ulcer of the leg developing on a Basis of Eczemaand varicose veins, ULCER AND ULCP^RATION. 179 (e) Pressure Ulcer.—A pressure ulcer is likely to develop whenever mechan-ical pressure, even of moderate degree, is exerted upon some part of the surfaceof the body for a certain length of time, and more especially if the nutrition of thepart thus subjected to pressure be imperfect. A special form of pressure ulcer hasbeen described as occurring on the plantar surface of the foot. In this ulcer thefirst stage obserNccl is the formation of a callosity or thickening of the epidermis,beneath which an infective inflammation and suppuration take place; and ulti-
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