Ulcers are a break in the skin. They may be down to different depths, including, but not limited to, breakdown of skin, fat layer exposed, past fat layer, down to tendon and bone. 3 types of ulcers include neuropathic diabetic ulcers, arterial ulcers, and venous ulcers. Arterial ulcers should never be debrided, and they often occur on the tips of the pedal digits. Venous ulcers are located in the medial ankle, and the mainstay is Unna boot compression therapy. Neuropathic diabetic ulcers are perhaps the most common, and the mainstay is debridement, offloading, and proper wound care modalities.
Dr. Zhang is very skilled in ulcer management, and uses a wide variety of agents including Santyl, Silvadene. X-rays are part of ulcer management to ensure the ulcer does not go to bone, causing osteomyelitis.