Phlegmon consequences after surgery. Phlegmon of the anterior abdominal wall, phlegmon of the scrotum, urethral-scrotal fistula (clinical case)

Abdominal wall phlegmon most often occurs directly near the surgical wound, especially in the right flank, since the most common reason for its development is destructive forms of acute.

Symptoms of phlegmon of the abdominal wall

The development of a purulent inflammatory process in the first days is masked not only by the fact that the process spreads under the thick muscle layers, between them and the transverse fascia, but mainly because the causative agents of phlegmon are in most cases intestinal microorganisms and, in particular, E. coli. This essentially putrefactive microbe does not immediately cause the development of violent suppuration and other usual acute inflammatory manifestations. Its general intoxicating properties prevail over local purulent-inflammatory ones. Because of this, at the beginning of the development of deep phlegmons of the abdominal wall directly at the surgical wound, local manifestations can be very minor or almost imperceptible. It should not be overlooked that despite the apparent initial calm in the wound, the patient experiences an increase in temperature, a slight rapid pulse, poor sleep, upset appetite, lethargy, apathy and poor health in combination with mild irritation of the peritoneum, with stool retention or, conversely, , with causeless glorifications. The unusual color of the face is noteworthy: it is either unnaturally pale or excessively cyanotic. Initially, the thought of pneumonia arises; however, careful research involving and does not support this assumption. A blood test usually shows a significant increase in leukocytosis, the disappearance of eosinophils, an increase in neutrophilia and an increase in the number of rod forms. By day 5-6, local changes usually become noticeable, most often lateral to the surgical wound.

Treatment of phlegmon of the abdominal wall

It is usually not possible to detect pus by removing several skin sutures and carefully spreading the edges of the wound, and this does not bring clarity to the recognition of phlegmon. The patient's condition does not improve. Only after 1-2 days have all the skin sutures been removed, the edges of the wound have been spread along its entire length and, having seen that the tissues near the aponeurotic sutures are suspiciously gray and dark, will these sutures be removed, and then the muscles have been widely separated from under muscles will begin to be released in small quantities, with the smell of E. coli, pus-like masses. Tamponade, tubular and application, affecting intestinal microbes, usually leads to a relatively rapid improvement in the patient's condition.

The article was prepared and edited by: surgeon

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We cannot do without injuries and bruises in our lives. Often, the consequences of these incidents are a disease called phlegmon - an inflammatory, purulent process that occurs in fatty tissue.

The peculiarity of this disease is that it has no clear boundaries and rapidly spreads to nearby skin. Also, in advanced forms, the disease spreads to the muscles and bones; surgical intervention cannot be avoided.

Causes

This disease is caused by an infection called Staphylococcus aureus, Streptococcus, and Escherichia coli. Microorganisms penetrate deep skin in various ways:

• as a result of injury, cuts, surgery;
• after a large abscess;
• animal bite;
• during an infection in the body (tonsillitis, caries);
• introduction of harmful chemical compounds under the skin;
• weakened immune system;
• the presence of chronic diseases increases the risk of infection (tuberculosis, HIV infection, diabetes mellitus);
• drug addiction and alcoholism also contribute to the acute occurrence of phlegmon.

In a normal situation, a capsule forms around the damaged area of ​​skin, the body tries to stop the infection. If one or more of the factors listed above are present, this process does not occur. Harmful microorganisms penetrate deep under the skin, provoking an inflammatory, purulent process.

First signs and symptoms

The first alarm bells when this disease develops are:

• general malaise,
• elevated temperature,
• lethargy,
• thirst,
• swelling of the affected area,
• pain,
• characteristic redness without clear contours.

As a rule, phlegmon of the hand, neck, leg and other parts of the body progresses rapidly. Over time, pus, blisters, necrotic tissue, and ulcers appear. Do not put off going to the doctor; acute complications can cause serious harm to the body.

In severe forms of phlegmon, blood pressure decreases, heart rhythm is disturbed, breathing is difficult, nausea, and vomiting. Nearby organs also suffer, they are compressed, resulting in pain and tingling.

Classification of the disease

Each disease has different stages of development; today we will consider the forms of soft tissue phlegmon:

• anaerobic. An extensive inflammatory, necrotic process is observed, the skin is severely affected, covered with blisters, and when pressed, pus flows out;
• putrid. Destroyed tissues acquire an unpleasant odor and are brown or green in color. This indicates that the infection has spread into the deeper layers of the skin;
• necrotic. Dead tissue zones are formed, completely absorbed by the disease;
• purulent phlegmon. Ulcers appear, yellowish pus is released, the disease begins to affect the ligaments and muscles;
• serous. The mildest of all forms of phlegmon. It is characterized by swelling of the affected areas, inflammation, and itching. There are no clear boundaries between healthy tissues and diseased tissues.

This disease can be acute (spontaneous infection) or chronic (the disease does not go away and returns again).

Depending on the location of the disease, there are facial, lumbar, foot, etc. Any part of the human body where there is an infection is susceptible to this pathology.

Phlegmon of newborns and older children

Children are highly susceptible to this disease. Their immunity is not as strong as that of adults + a huge number of injuries, wounds (broken knees, fights at school), frequent infectious diseases (sore throat, otitis, bronchitis, flu). The usual localization of phlegmon in children is the face, limbs, and cervical spine.

High activity promotes rapid blood flow. Thanks to this nuance, bacteria quickly spread throughout the body, provoking an acute form of the disease.

The child should be treated only after noticing the first symptoms. After all, the baby’s body cannot cope with the infection on its own.

Pregnant

Treatment is carried out very carefully, comparing the expected positive effect for the mother with harm to the fetus.

Diagnosis of the disease

The attending physician will easily identify the disease in its initial stages. The characteristic swelling and redness will “give over” to phlegmon. But purulent wounds and ulcers should be studied to understand the cause and the exact name of the infection. For this purpose, ultrasound, tomograms, and radiography are performed. In difficult cases, they resort to puncture and biopsy.

All these methods help to study the degree of development of the disease and accurately determine the pathogen. These manipulations are the key to successful treatment.

Treatment with drugs

The initial stages are treated with antibiotics, painkillers, and immunity-boosting drugs. Anti-inflammatory ointments, creams or injections with a suitable solution are also prescribed.

The option of removing the pus by a doctor and subsequent home treatment is possible: applying bandages with levomekol to the affected area, taking anti-inflammatory drugs, vitamins.

You should also stop taking alcohol or drugs, as there may be a risk of re-infection.

Advanced stages require immediate hospitalization of the patient and urgent surgical intervention.

The essence of this method is to remove the source of infection and prevent it from spreading to other areas of the skin. If the inflammatory process has not stopped, the temperature persists, and pus appears, then the last resort is amputation of the limb.

To enhance the effect and quick recovery, doctors recommend combining drug therapy and treatment with folk remedies.

Traditional methods and recipes

In times of absence of antibiotics, our ancestors used various medicinal herbs and plants. Why not use them now? Let's consider some effective means in the fight against phlegmon:

• take 200 gr. vodka, 50 gr. St. John's wort and propolis. Mix all the ingredients to obtain a tincture. Store in a cool, dark place for about a week. Dilute the product with water (two teaspoons of the drug per glass of liquid). Then lubricate the affected areas of the body with this product or rinse the mouth (for swelling of the neck and face);
• Eucalyptus is a miracle plant that relieves swelling and inflammation. Infuse a mixture of 100 g of leaves and 1 liter of boiling water for two hours. Take 100 g of this product orally every day. This decoction improves immunity;
• pour 2 tablespoons of cloves into half a liter of water, boil for 5 minutes. Strain the broth, let it brew, apply to the sore spot 5 times a day for 30 minutes;
• Birch buds will also come in handy. Pour 10 g of kidneys into 200 ml of boiling water. Leave for about an hour, strain. Compresses with this decoction perfectly relieve inflammation, and taking a tablespoon orally 2 times a day helps improve immunity;
• basil, St. John's wort, birch leaves. Mix all ingredients in equal proportions. Pour 1 tablespoon of the mixture into 300 ml of boiling water. Let it sit for an hour. Drink 3 tablespoons of the decoction 3-4 times a day.

The following tips will help you avoid a bad fate:

• prevent injuries and abrasions (be careful);
• follow safety rules in the workplace and at home;
• if a cut could not be avoided, treat the wound immediately, do not let things take their course;
• remove all foreign bodies immediately + disinfect the affected area. Remember: even a small splinter can lead to unpleasant consequences;
• do not abuse alcohol;
• treat chronic diseases, do not allow your immune system to weaken.

Cellulitis is a disease that spreads quickly and has a huge range of complications. If the disease is left to take its course, death is inevitable. The infection spares no one. Follow safety rules and take preventive measures. Unable to avoid infection? See a doctor immediately and you will be absolutely healthy!

In the following video you can clearly see the process of treating foot phlegmon:

Phlegmon is a diffuse purulent inflammation of subcutaneous fat or cellular spaces. With phlegmon, the purulent process is not limited to one area, but spreads throughout the cellular spaces. This is a severe purulent process, the progression of which can lead to.

Table of contents:

Causes

Cellulitis develops when pathogenic microflora penetrates the cellulose. The causative agents are most often Enterobacteriaceae and Escherichia coli.

First, serous infiltration of the tissue occurs, then the exudate becomes purulent. Foci of necrosis appear, merging with each other, thereby forming large areas of tissue necrosis. These areas are also subject to purulent infiltration. The purulent-necrotic process spreads to adjacent tissues and organs. Changes in tissues depend on the pathogen. Thus, anaerobic infection entails tissue necrosis with the appearance of gas bubbles, and coccal pathogens result in purulent melting of tissue.

Microorganisms invade fatty tissue through contact or hematogenous routes. Among the most common causes of phlegmon are:

• Soft tissue injuries;
• Purulent diseases (, carbuncles,);
• Violation of antiseptics during medical procedures (injections, punctures).

All phlegmons are divided into superficial (when the subcutaneous tissue is affected up to the fascia) and deep (when the deep cellular spaces are affected). The latter usually have separate names. Thus, inflammation of the peri-rectal tissue is usually called, and the inflammation of the peri-renal tissue is called paranephritis.

Depending on the location, the following types of phlegmon are differentiated:

• Subcutaneous;
• Submucosa;
• Subfascial;
• Intermuscular;
• Retroperitoneal.

With superficial (subcutaneous) localization of phlegmon, severe pain, redness of the skin without clear boundaries, and a local increase in temperature occur. There is swelling on the skin, which then softens somewhat in the center. A symptom of fluctuation appears.

With deep phlegmon, a painful, dense infiltrate without sharply defined boundaries is palpated. Regional. With deep phlegmon, the symptoms of general intoxication are always very pronounced. Patients complain of weakness and fever. There is also an increase in heart rate, a drop in blood pressure, shortness of breath,.

Deep cellulitis of the neck

The primary foci, which then become the source of phlegmon of the neck, are pustules in the scalp and face, as well as inflammatory processes in the mouth (teeth), in the upper respiratory tract, esophagus, osteomyelitis of the cervical vertebrae, penetrating wounds of the neck.

Features of the appearance of phlegmon in the neck area are due to the following factors:

• The presence of a highly developed network of lymphatic vessels;
• Features of the structure of the cervical fascia, between which there are delimited spaces filled with loose fiber.

With phlegmon of the neck, a swelling of the skin forms in the area of ​​the sternocleidomastoid muscles, lower jaw, and chin. The swelling is initially dense, sometimes lumpy.

With superficial submandibular phlegmon in the chin area, the skin becomes red, swelling and pain are observed. And with deep phlegmon, very pronounced swelling occurs in the area of ​​the floor of the mouth and lower jaw. Patients note a sharp pain, which intensifies when chewing.

With phlegmon stretching along the cervical neurovascular bundle, due to severe pain, patients avoid any movements of the head and therefore keep it turned and slightly tilted towards the painful side.

This is a purulent process in the mediastinal tissue. Basically, mediastinitis is a complication of perforation of the trachea and esophagus, purulent processes in the pharynx and mouth, in the lungs, phlegmon of the neck, hematoma of the mediastinum, osteomyelitis of the sternum and thoracic spinal column.

Purulent mediastinitis usually develops rapidly, accompanied by an increase in temperature, as well as pain behind the sternum, which spreads to the back, neck, and epigastric region. Swelling appears in the neck and chest area. Patients, trying to relieve pain, take a sitting position and try to keep their head tilted forward.

In addition, increased heart rate, decreased blood pressure, pain when swallowing and breathing, and dilation of the neck veins are observed.

This is a purulent inflammation that spreads through the intermuscular, perivascular spaces. The cause of purulent inflammation of the extremities can be any damage to the skin (wounds, bites), as well as diseases such as osteomyelitis, purulent arthritis, panaritium.

The disease is characterized by diffuse pain in the limbs, increased body temperature, and severe weakness. The onset of the disease is acute and rapid. There is tissue swelling, enlargement of regional lymph nodes, and the limb increases in size.

When the phlegmon is located superficially (for example, in the femoral triangle), hyperemia and swelling of the skin are observed, a symptom of fluctuation.

This is an acute purulent process in the retroperitoneal tissue of the lumbar and iliac regions, which occurs as a result of acute appendicitis, osteomyelitis of the pelvic bones, spinal column, inflammatory processes in the kidney, and intestinal perforations. Depending on the location of the purulent process in the retroperitoneal tissue, there are:

• Paranephritis;
• Paracolite;
• Phlegmon of the iliac fossa.

In the initial period of the disease, clinical signs are not clearly expressed. First, nonspecific symptoms of inflammation occur in the form of fever, weakness, and headache. Local symptoms in the form of pain and tissue swelling appear somewhat later. The localization of pain corresponds to the location of the purulent process. Often the doctor is able to palpate the inflammatory infiltrate through the anterior abdominal wall. Due to pain, a person has difficulty moving, so to alleviate the condition, he tends to bend forward with an inclination towards the painful side.

With phlegmon of the retroperitoneal space, a contracture of the thigh is formed - the thigh assumes a flexion position with inward rotation and slight adduction. Psoas symptom occurs due to a reflex contraction of the iliopsoas muscle. Trying to straighten the limb increases the pain.

Paraproctitis

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This is a purulent inflammation of the tissue surrounding the rectum. The causative agents of the disease are often Escherichia coli, staphylococci, which enter the peri-rectal space through cracks in the posterior process, from inflamed hemorrhoids.

The following forms of paraproctitis are distinguished:

1. Subcutaneous;
2. Ishiorectal;
3. Submucosa;
4. Pelviorectal;
5. Retrorectal.

Subcutaneous paraproctitis located in the anal area. A person is bothered by sharp pain in this area, which intensifies during bowel movements. Swelling and hyperemia of the skin will be clearly visible. An increase in temperature is also recorded.

Submucosal paraproctitis is located in the submucosal layer of the rectum and is less painful.

Ishiorectal paraproctitis proceeds more severely. The purulent process involves the tissue of the ischiorectal cavities and pelvis. Patients feel throbbing pain in the rectum. It is noteworthy that swelling and hyperemia of the skin occur in the later stages of the disease.

Pelviorectal paraproctitis occurs above the pelvic floor. In the first days of illness, a person is bothered by general symptoms: weakness, fever. Then pain appears in the perineum and lower abdomen, frequent urination, stool retention, and tenesmus.

Retrorectal paraproctitis differs from pelviorectal only in that first the purulent focus is localized in the tissue behind the rectum, and only then can descend into the ischiorectal tissue.

The occurrence of post-injection phlegmon is caused by a violation of the technique of administering medications and the rules of antiseptics during manipulations. The properties of the medication itself also play a role. Thus, hypertonic and oil solutions of drugs (cordiamin, vitamins, analgin, magnesium sulfate) often provoke the formation of post-injection purulent complications.

Note:medications should not be administered into the subcutaneous tissue, but into the muscle tissue. This will prevent post-injection purulent complications.

The occurrence of phlegmon is also caused by the presence of chronic diseases, excessive contamination of the skin with microorganisms, etc. Thus, in obese people, subcutaneous fat tissue is highly developed, and when the medicine is administered with short needles, it simply does not reach its final destination - the gluteal muscle. Therefore, when performing injections in such situations, the medicine does not enter the muscle, but the subcutaneous tissue.

The disease often occurs suddenly with the appearance of swelling, redness and pain at the injection site. Patients experience fever and lymphadenitis.

Important! Treatment of patients with phlegmon is always carried out in a hospital. In the initial stages of the disease, conservative therapy is allowed, the basis of which is intramuscular administration. The use of physiotherapeutic procedures is allowed.

With progressive phlegmon, surgical treatment should be performed as early as possible. The operation is performed under general anesthesia. The surgeon opens the phlegmon by dissecting the skin and subcutaneous tissue along its entire length.

After tissue dissection, pus is evacuated. Then the surgeon inspects the purulent cavity and excises necrotic tissue. For better drainage, additional incisions are made - counter-apertures.

After surgical procedures, the wound is treated with three percent hydrogen peroxide, then tamponed with gauze soaked in antiseptic.

In the postoperative period, wound dressings are regularly carried out, and antibiotics are prescribed.

If no improvement is observed after surgery, a complication should be suspected: progression of phlegmon, erysipelas, sepsis.

Grigorova Valeria, medical observer

Cellulitis is a purulent inflammation of soft tissues, characterized by a fairly rapid spread in the area of ​​muscles, tendons and fiber, as well as their impregnation with exudate. Phlegmon is characterized by localization in any part of the body, and in an advanced form, internal organs can be affected.

Staphylococci, streptococci, Pseudomonas aeruginosa can play the role of the main causative agents of purulent phlegmon of the neck, face, hand or other part of the body. Obligate anaerobes, which actively reproduce in conditions of complete absence of oxygen, can cause the development of a severe form of the disease.

What it is?

Cellulitis is an acute purulent inflammation of fatty tissue that does not have clear boundaries. The adipose tissue surrounding various organs, nerves and blood vessels communicates with nearby areas. Therefore, a purulent process, having arisen in one place, can very quickly spread to neighboring areas, causing damage to the skin, muscles, tendons, bones and internal organs.

Reasons for development

Cellulitis develops when pathogenic microflora penetrates the cellulose. The causative agents are most often staphylococci, streptococci, Proteus, Pseudomonas aeruginosa, Enterobacteriaceae, and Escherichia coli.

First, serous infiltration of the tissue occurs, then the exudate becomes purulent. Foci of necrosis appear, merging with each other, thereby forming large areas of tissue necrosis. These areas are also subject to purulent infiltration. The purulent-necrotic process spreads to adjacent tissues and organs. Changes in tissues depend on the pathogen. Thus, anaerobic infection entails tissue necrosis with the appearance of gas bubbles, and coccal pathogens result in purulent melting of tissue.

Microorganisms invade fatty tissue through contact or hematogenous routes. Among the most common causes of phlegmon are:

• Soft tissue injuries;
• Purulent diseases (carbuncles, osteomyelitis);
• Violation of antiseptics during medical procedures (injections, punctures).

Types and locations of phlegmon

Taking into account the classification of phlegmon by anatomical location, the following types of pathology can be particularly distinguished:

1. Serous – the initial form of phlegmonous inflammation. It is characterized by the formation of inflammatory exudate, as well as intensive attraction of leukocytes to the pathological focus. At this stage, a palpable infiltrate appears, as the fiber is saturated with a turbid gelatinous liquid. There is no clearly defined boundary between healthy and inflamed tissues. In the absence of timely prescribed treatment, a rapid transition to a purulent or putrefactive form is observed. The development of one form or another is associated with causative microorganisms that entered the entrance gate
2. Putrefactive - caused by anaerobic microorganisms that emit certain unpleasant odors during their life processes. The affected tissues are brown or green in color, disintegrate into a gelatinous mass and emit a foul odor. This creates conditions for the rapid penetration of toxic substances into the systemic bloodstream with the development of severe intoxication, leading to failure of many organs.
3. Purulent - pathogenic microorganisms and enzymes released from phagocytes lead to the digestion of tissues and their necrosis, as well as purulent secretion. The latter represents dead leukocytes and bacteria, and therefore has a yellowish-green color. Clinically, this form corresponds to the appearance of cavities, erosions and ulcers, which are covered with purulent plaque. With a sharp decrease in a person’s immune forces, the phlegmonous process spreads to muscles and bones with their subsequent destruction. The main diagnostic sign at this stage is the absence of muscle bleeding upon slight scraping.
4. Anaerobic. In this case, according to the morphological characteristics, the process is serous in nature, but gas bubbles are released from the areas of necrosis. Due to their presence in the tissues, a characteristic sign appears - mild crepitus. Hyperemia of the skin is slightly expressed, and the muscles have a “cooked” appearance.
5. Necrotic. It is characterized by the appearance of dead areas that are clearly demarcated from healthy tissue. The border between them is a leukocyte shaft, from which a granulation barrier is subsequently formed, while necrotic areas can melt or be rejected. Such delimitation leads to the formation of abscesses that are prone to spontaneous opening.

The area where phlegmon occurs may vary. However, as practice shows, the following parts of the body are most often affected by this type of purulent lesion of fatty tissue (phlegmon):

• breast;
• hips;
• buttocks;
• back (especially its lower part);
• sometimes - the face and neck area.

Also, depending on the location of phlegmon, it is divided into the following types:

1. Subfascial.
2. Subcutaneous, which progresses directly into the subcutaneous fat layer.
3. Intermuscular, which is usually accompanied by ongoing or progressive inflammatory processes in the muscle layer.
4. Perinephric, accompanied or caused by kidney diseases - this is how pathogenic microflora penetrates into this area.
5. Retroperitoneal (phlegmon of the retroperitoneal space), detected by conducting a general examination of the abdominal cavity when the patient frequently complains of pain in the abdominal area.
6. Pararectal, located near the rectum and its origin is due to the penetration of pathogenic microorganisms through the walls of the rectum. The most common cause of phlegmon in this case is long-term constipation and intestinal instability.

Since the main reason for the appearance of phlegmon should be considered the penetration of pathogenic microorganisms into the tissues of adipose tissue, breaks and cracks in the skin, these places require special attention in case of any mechanical damage.

Symptoms

Phlegmon in acute forms develops quickly. Patients experience a significant increase in temperature above 40°C, which is accompanied by chills, headaches, thirst and dry mouth. Against the background of general intoxication, weakness and drowsiness are observed. Nausea and vomiting often occur. Blood pressure is increased, heart rhythms are disturbed. The number of urinations in the patient is reduced until they stop completely.

A lump with swelling appears on the affected area, it feels hot to the touch, and the skin becomes shiny. It is not possible to define clear boundaries of education. There is significant pain in this area, the lymph nodes located near the source of inflammation are enlarged. With the further development of the disease, the compacted areas tend to soften, forming purulent cavities, the filling of which sometimes independently breaks out through the fistula or spreads further through neighboring tissues, provoking further inflammation and the process of destruction.

The symptoms of deep phlegmon are more pronounced and appear in the early stages.

Cellulitis of the neck

Abscesses and phlegmons of the neck are classified as diseases whose course is unpredictable, and the consequences can be very severe and even life-threatening for the patient. In most cases, the source of pathogenic infection in case of phlegmon of the neck is inflammatory processes in the oral cavity and pharynx - chronic dental caries and similar diseases.

Superficial abscesses and phlegmons of the neck most often arise above the deep cervical fascia and therefore they do not pose any particular danger, since they are easily accessible for surgical opening. Most neck phlegmons are localized in the chin and submandibular areas. The clinical picture for this type of phlegmon is as follows: the general temperature rises to 39 degrees Celsius, the patient experiences severe headaches, general weakness and malaise.

A laboratory blood test indicates an increased level of white blood cells. In the absence of timely treatment, phlegmon progresses and inflammation spreads to large veins of the facial area, and there is also a risk of purulent meningitis.

Phlegmon of the hand

Occurs in the deep subcutaneous areas of the hand. As a rule, inflammation occurs as a result of purulent infection through scratches, wounds and cuts. There are the following subtypes of phlegmon of the hand: on the middle palmar area, on the eminence of the thumb and phlegmon in the form of a cufflink. Phlegmon of the hand can form anywhere in the hand space with subsequent spread to the back of the hand. The patient feels severe throbbing pain, the tissue of the hand swells significantly.

Facial phlegmon

This is a rather severe subtype of the disease, occurring mainly in the temporal region, near the jaw and under the masticatory muscles. With facial phlegmon, the patient experiences severe tachycardia and an increase in body temperature of up to 40 degrees, facial tissues swell greatly, and chewing and swallowing functions are impaired.

Patients with suspected facial phlegmon should be immediately hospitalized in a specialized medical facility (dental surgical department). In the absence of treatment for facial phlegmon, the prognosis is always extremely unfavorable.

What does phlegmon look like: photo

The photo below shows how the disease manifests itself in humans.

Diagnostics

The attending physician will easily identify the disease in its initial stages. The characteristic swelling and redness will “give over” to phlegmon. But purulent wounds and ulcers should be studied to understand the cause and the exact name of the infection. For this purpose, ultrasound, tomograms, and radiography are performed. In difficult cases, they resort to puncture and biopsy.

All these methods help to study the degree of development of the disease and accurately determine the pathogen. These manipulations are the key to successful treatment.

How to treat phlegmon?

Treatment of phlegmon is carried out exclusively in a hospital setting. Initially, it is necessary to eliminate the pus; accordingly, treatment begins with the evacuation of purulent exudate - opening and drainage. Excision of necrotic areas occurs, as well as additional opening and excision when pus spreads. This procedure is not carried out only when the phlegmon is at the initial stage of its development, when pus has not yet formed.

How to treat phlegmon? This is where physiotherapy becomes effective:

1. Dubrovin dressing (compress with yellow mercury mixture).
2. Dermoplasty.
3. UHF therapy.
4. Sollux lamp.
5. Warming compresses and heating pads.
6. Infusion therapy.

Medicines are actively used to promote recovery and rejection of dead tissue:

1. Painkillers.
2. Antibiotics.
3. Calcium chloride solution.
4. Glucose solution.
5. Adonilen, caffeine and other drugs that improve cardiovascular function.
6. Antigangrenous serums.
7. Hexamine solution.
8. Proteolytic enzymes.
9. Ointment with enzymes – iruksol.
10. Sea buckthorn and rosehip oil.
11. Troxevasin.
12. General strengthening agents.
13. Immunomodulators.

Treatment is not carried out at home, so as not to provoke chronicity of the disease or the spread of pus. The diet includes drinking plenty of fluids and eating foods rich in vitamins. The patient is kept in bed with elevation of the affected limb.

Complications of cellulitis

If treatment is not treated in a timely manner, such general complications as sepsis (the entry of microorganisms into the blood and the spread of infection throughout the body), thrombophlebitis (purulent inflammation of the veins with the formation of blood clots and microabscesses), purulent arteritis (destruction of the artery wall by microorganisms with the development of massive bleeding, which is very difficult) are possible. stop), secondary purulent leaks as the process spreads.

Depending on the location of the phlegmon, specific complications are also identified, for example, purulent meningitis (inflammation of the meninges) with phlegmon of the orbit, or mediastinitis (inflammation of the mediastinal organs) with phlegmon of the neck.

Prevention

The main measures to prevent the occurrence and development of the disease are to minimize the risk of various microtraumas at work and at home. You should also remember the rules for providing first aid for injuries, as well as in the presence of embedded foreign bodies.

Phlegmon can develop in the subcutaneous tissue, under the fascia and aponeuroses, in the submucosal and muscle tissue, and if it progresses rapidly, it can affect a number of anatomical areas, such as the thigh, gluteal and lumbar regions, perineum, and anterior abdominal wall. If phlegmon develops in the tissue surrounding a particular organ, then to designate this disease they use a name consisting of the prefix “para” and the Latin name for the inflammation of this organ (paranephritis, inflammation of the perinephric tissue, parametritis, inflammation of the pelvic tissue, etc.).

Cellulitis is an independent disease, but it can also be a complication of various purulent processes (carbuncle, abscess, etc.).

Causes of phlegmon

The development of phlegmon is caused by the penetration of pathogenic microorganisms into the soft tissues. The causative agents are usually staphylococci and streptococci, but can also be caused by other pyogenic microbes that penetrate the fiber through accidental damage to the skin, mucous membranes or through the blood.

Purulent phlegmon is caused by pyogenic microbes, staphylococci, streptococci, Pseudomonas aeruginosa, etc. When E. coli, Proteus vulgaris, and putrefactive streptococcus penetrate the tissue, putrefactive phlegmon develops. The most severe forms of phlegmon are caused by obligate anaerobes that reproduce in the absence of oxygen. Gas-forming spore-forming anaerobes (clostridia) and non-spore-forming anaerobes (peptococci, peptostreptococci, bacteroides) have extremely aggressive properties, and therefore the development of inflammation in soft tissues and its spread occurs very quickly.

Cellulitis can also be caused by the introduction of various chemicals (turpentine, kerosene, gasoline, etc.) under the skin.

The rapid spread of purulent inflammation through the cellular spaces is mainly associated with a decrease in the protective functions of the body during exhaustion, long-term chronic diseases (blood diseases, diabetes mellitus, etc.), chronic intoxication (for example, alcohol), various immunodeficiency states, and the ability of microorganisms to multiply quickly , secrete toxins and enzymes that destroy tissue.

Manifestations of phlegmon

According to the course, acute and chronic phlegmon is distinguished; according to localization, subcutaneous, subfascial, intermuscular, organ, interorgan, retroperitoneal, pelvic, etc. Acute phlegmon is characterized by a rapid onset, high temperature (40°C and above), weakness, thirst, rapid appearance and spread of painful swelling, diffuse redness of the skin over it, pain, dysfunction of the affected part of the body.
The swelling increases, the skin above it turns red and shiny. When palpated, a painful compaction without clear boundaries is determined, motionless, hot to the touch. As a result, you can determine a feeling of softening in the area of ​​compaction or a fistula is developing.

Malignant forms are often encountered, when the process rapidly progresses, involving large areas of subcutaneous and intermuscular tissue and is accompanied by severe intoxication.

With the secondary development of phlegmon (purulent arthritis, purulent pleurisy, peritonitis, etc.), it is necessary to identify the underlying disease.

At serous phlegmon, the fiber has a gelatinous appearance, is saturated with a turbid watery liquid, along the periphery the inflammatory process without a clear boundary passes into unchanged tissue. As the process progresses, the penetration of soft tissues increases sharply, and the liquid becomes purulent. The process can spread to muscles, tendons, and bones. The muscles become gray in color, soaked in yellow-green pus, and do not bleed.

Putrid phlegmon , characterized by the development of multiple areas of necrosis in the tissue, melting of tissues, copious purulent discharge, with a foul odor.
Anaerobic phlegmon is characterized by widespread serous inflammation of soft tissues, extensive areas of necrosis (death) and the formation of multiple gas bubbles in the tissues.

Chronic phlegmon is characterized by the appearance of a woody density infiltrate, the skin over which acquires a bluish tint as a result of the penetration of mildly infectious microbes through the wound.

One type of chronic phlegmon is woody phlegmon (Reclus phlegmon) - the result of infection by microorganisms of the floor of the mouth and oropharynx. The appearance of a painless, “hard as a board” infiltrate of the soft tissues of the neck is typical.

Complications of cellulitis

Complications develop where the process is not stopped in time. This is due either to the late presentation of the patient or to difficulties in diagnosis.

Cellulitis that occurs primarily can lead to a number of complications (lymphangitis, erysipelas, thrombophlebitis, sepsis, etc.). The spread of the process to surrounding tissues leads to the development of purulent arthritis, tenosynovitis and other purulent diseases. Facial phlegmon can be complicated by progressive facial veins and purulent meningitis.

In the postoperative period, in addition to active local treatment, intensive intravenous infusion therapy, targeted antibiotic treatment, and immunomodulatory therapy are necessary.

What can you do?

If the symptoms described above appear, you should immediately consult a doctor.
Cellulitis is an acute disease that spreads quickly, and if there is a decrease in immunity, the disease can lead to irreversible consequences, including death.