. American practice of surgery ; a complete system of the science and art of surgery . 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 obse
. American practice of surgery ; a complete system of the science and art of surgery . 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-. FiG. 29.—Ulcerations of the Sole of the Foot, due to Tabes. (• CliniquesMedicales Iconographiques,par Haushalter, Etienne, Spillmann et Thiry, Paris, 1901.) mately there remains, as a result of these inflammatory changes, a deep ulcerwith markedly indurated and thickened edges. The usual form of pressure ulcer is seen in the simple or ordinary bed-sorein a patient suffering from some long and serious illness, with feeble cardiacaction and lessened tissue vitality. In such a case, if the prominent portionsof the body, as the promontory of the sacrum and other bony points, are sub-jected to pressure, anaemia and necrosis of the soft parts follow; and in addition,if secondary infection should ensue, extensive destruction may take place. (/) Ulcer due to Defective Innervation (Fig. 29).—This variety of ulcer is theresult primarily of deficient innervation, and may occur in a number of nerve 180 AMERICAN PRACTICE OF SURGERY. lesions in which the nerve supply to a region becomes
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