Marjolin Ulcer

Q) True about Marjolin's ulcer

a) lymphatic spread is common

b) They are painful

c) Aggressive and fast growing tumors

d) Squamous cell carcinoma is the most common type

d. squamous cell carcinoma

When a SCC or BCC occurs in a long standing scar, it is called marjolin's ulcer.

Marjolin's type of ulcer is a malignant change that can occur in any long standing ulcer (ie venous ulcer)

Scar tissue is devoid of lymphatics, so no lymphatic spread. Lymphatic spread can still occur when it invades normal tissue. also nerve endings are not in scar tissue, so pain is a late feature

They are slow growing tumors, and squamous cell carcinoma is the most common type. Slow growth is again due to avascular characterstic

Pressure sore

Q) Pressure sore, grade II is

a) Partial thickness skin loss, epidermis and dermis are involved

b) Full thickness skin loss, involving subcutaneous tissue but not underlying fascia

c) Non blanchable erythema, no breach in epidermis

d) Involvement of bones and tendons

Ans a

Pressure sores occurs when ext pressure exceeds the capillary occlusive pressure (30 mmHg) approximately 5% of all hospitalised patients

Stage                   Description

1                        Non-blanchable erythema without a breach in the epidermis

2                       Partial-thickness skin loss involving the epidermis and dermis

3                       Full-thickness skin loss extending into the subcutaneous tissue but not through underlying fascia

4                        Full-thickness skin loss through fascia with extensive tissue destruction, maybe involving muscle, bone, tendon or joint

Bailey - page 29


Suturing in vascular anastomosis

Q) True about suturing technique in vascular anastomosis

a) Anastomosis may not be completely water tight

b) To prevent intimal injury needle should be moved from with in to out

c) 4-0 suture is preferred for aorta

d) Any bio degradable suture which is monofilament can be used



Vessels should always be sewn with the needle moving from within to without on the downstream edge of the vessel to avoid creating an intimal flap and to fix any atherosclerotic plaque.

Tip of the needle should be at right angle to the intima and curve of the needle should be followed

Distal clamp is released first

Non absorbable sutures should be used

2-0 should be used for aorta 4-0 for femoral and 6-0 for popliteal

Only non absorbable monofilament sutures are used in vascular anastomosis

Bailey 27 page 99