Ulcer (soft tissue)

An Ulcerulcer refers to the break in the skin, epithelium, or mucous membrane resulting in the discontinuity in the surface tissue, necrosis, and often pus formation ¹.

Risk factors

• immuno-compromisedimmunocompromised (e.g. diabetics) ¹
• immobile patients ^{1, 2,2}
• advanced age ²
• poor nutrition ²
• increased moisture ²
• poor perfusion ^{1, 2,2}
• skin infection ^{1, 2,2}

Radiographic features

MRI

MRI can evaluate the extent of the spread of soft tissue infection and access the osseous or articular extension ¹. It can also be used to optimise surgical planning by mapping the extent of ulcer and soft tissue infection, thereby reducing resection ³. 

MRI appearance of an ulcer can be a focal skin/soft tissue defect with raised margins. Ulcer granulation tissues typically demonstrate ¹:

• T2/T2FS: hyperintense
• T1 C+: marked peripheral enhancement

Eschar should be recognised as non-enhancing tissue overlying ulcerated area. 

RadiologicalRadiology report

The radiologicalradiology report should contain a description of the following:

• presence, location, and size of the ulcer
• any associated findings ¹:
  • extent of the soft tissue infection.
  • osseous involvement.
  • extension into the joint.

Practical points

• The field of view should be centred on the region of interest ¹.
• Aa marker should be placed adjacent to the shallow ulcers because they can be challenging to localise on imaging ¹.