A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . granula-tions, and the edges become irregular and sharp-cut. This constitutesa phagedenic, or sloughing ulcer ; which is a rather contradictory term. The devitalized skin or muscle is oftenfound in the discharge from such anulcer, as shreds and tags of tissue. When the granulations are exuberantand project like excrescences beyondthe level of the skin the ulcer is calleda fungous ulcer. The callous or in-dolent ulcer is deeply e
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . granula-tions, and the edges become irregular and sharp-cut. This constitutesa phagedenic, or sloughing ulcer ; which is a rather contradictory term. The devitalized skin or muscle is oftenfound in the discharge from such anulcer, as shreds and tags of tissue. When the granulations are exuberantand project like excrescences beyondthe level of the skin the ulcer is calleda fungous ulcer. The callous or in-dolent ulcer is deeply excavated, hasindurated, whitish, and undermined orinverted borders, is surrounded bythickened and congested skin of a blu-ish color, shows imperfectly-formedpale granulations covered with a foul-smelling thin pus, and is usually in-sensible to painful contact. Such ulcersare of long duration, and may well betermed chronic. Ulcers may be com-plicated with, or may depend upon, varicose veins, impeded circulation,and diseased bone, or may be the seat of hemorrhage or malignant pro-cesses. Ulcers, otherwise healthy, are often the seat of a purulent Fig. 51 «£=£. Method of cutting small skin-grafts bymeans of needle and scalpel. TREATMENT. 49 discharge, because pyogenic germs Lave been allowed to come intocontact with the ulcerated surfaces. Chronic ulcers of the front of the leg are common ; and are due topoor circulation, chronic inflammatory processes and general ulcers above the level of the knee are usually syphilitic,tubercular or epitheliomatous. Their syphilitic origin should alwaysbe suspected, if they are clearly not due to injury. The infrequent lesion called perforating ulcer of the foot probablyincludes more than one form of ulceration. It usually occurs on thesole near the metatarso-phalangeal joint of the great toe or where thereis pressure. It is a chronic, painless ulcer, with thickened edges andoverhanging epidermis, and shows a tendency to exte
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