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

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

Symptoms of phlegmon of the abdominal wall

The development of a purulent inflammatory process in the early days is masked not only by the fact that the process spreads under the powerful muscle layers, between them and the transverse fascia, but mainly because the pathogens of phlegmon are in most cases intestinal microorganisms and, in particular, E. coli. This, in essence, putrefactive microbe does not immediately cause the development of violent suppuration and other usual acute inflammatory manifestations. Its general intoxication properties prevail over local purulent-inflammatory ones. Because of this, at the beginning of the development of deep phlegmon of the abdominal wall directly at the surgical wound, local manifestations can be very slight or almost imperceptible. It should not be overlooked that with the apparent initial calmness in the wound, the patient has an increase in temperature, there is some mildness of a rapid pulse, poor sleep, upset appetite, lethargy, apathy and feeling unwell, combined with slight irritation of the peritoneum, with stool retention, or vice versa , with causeless glorifications. The unusual color of the integument of the face attracts attention: it is either unnaturally pale or excessively cyanotic. Initially, the thought of pneumonia arises; however, a thorough study involving and does not confirm 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 the 5th-6th day, 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 is not improving. Only after all skin sutures are removed after 1-2 days, the edges of the wound are moved apart along its entire length and, having seen that the tissues near the aponeurotic sutures are suspiciously gray and dark, these sutures will also be removed, and then the muscles will be widely apart from under muscles will begin to stand out in a small amount, with the smell of Escherichia coli, purulent masses. Tamponade, tubular and application, affecting the microbes of the intestinal group, usually leads to a relatively rapid improvement in the patient's condition.

The article was prepared and edited by: surgeon

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In our life we ​​can not do without injuries and bruises. Often the consequences of these incidents is a disease called phlegmon - an inflammatory, purulent process that occurs in fatty tissue.

The peculiarity of this disease is that it does not have clear boundaries, it rapidly spreads to nearby skin. Also, in advanced forms, the disease spreads to muscles, bones, and one cannot do without surgical intervention.

Causes

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

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

In a normal situation, a capsule forms around the damaged area of ​​\u200b\u200bthe skin, the body tries to stop the infection. In the presence of one or more of the factors listed above, this process does not occur. Harmful microorganisms penetrate deep under the skin, provoking an inflammatory, purulent process.

First signs and symptoms

The first alarming bells, with the development of this disease are:

• general malaise,
• fever,
• lethargy,
• thirst,
• swelling of the affected area
• pain,
• characteristic redness, which does not have clear contours.

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

With a severe form of phlegmon, blood pressure decreases, heart rhythm is disturbed, breathing is difficult, nausea, and vomiting. Nearby organs also suffer, they are compressed, as a result: pain, tingling.

Disease classification

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

• anaerobic. There is an extensive inflammatory, necrotic process, the skin is severely affected, covered with bubbles, pus flows out when pressed;
• putrid. Destroyed tissues acquire an unpleasant odor, have a brown or green color. This indicates an infection that 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 lightest of all forms of phlegmon. It is characterized by swelling of the affected area, inflammation, itching. There are no clear boundaries between healthy tissues and diseased ones.

This disease can be acute (spontaneous infection) or chronic (the disease does not recede, it comes back again).

Depending on the location of the disease, there are facial, lumbar, foot space, 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 in adults + a huge number of injuries, wounds (broken knees, fights at school), frequent infectious diseases (tonsillitis, otitis media, bronchitis, influenza). The usual localization of phlegmon in children is the face, limbs, cervical region.

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

It is necessary to treat the child only after noticing the first symptoms. After all, the baby's body will not cope with the infection on its own.

pregnant

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

Diagnosis of the disease

The attending physician will easily determine the disease in its initial stages. Characteristic swelling, redness "surrender" phlegmon. But purulent wounds, ulcers should be studied in order to understand the cause, the exact name of the infection. For this, ultrasound, tomograms, x-rays are performed. In difficult cases, resort to puncture, biopsy.

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

Drug treatment

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

It is possible to remove pus by a doctor and follow-up home treatment: applying bandages with levomekol to the affected area, taking anti-inflammatory drugs, vitamins.

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

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

The essence of this method is to remove the source of infection, preventing its spread to other areas of the skin. If the inflammatory process has not stopped, the fever persists, pus appears, then the last method remains - amputation of the limb.

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

Folk methods and recipes

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

• take 200 gr. vodka, 50 gr. hypericum and propolis. Mix all the ingredients to get 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 remedy or rinse the mouth (with swelling of the neck, face);
• eucalyptus - a miraculous plant, relieves swelling and inflammation. For two hours, insist a mixture of 100 g of leaves and 1 liter of boiling water. Take 100 g orally of this remedy every day. This decoction improves immunity;
• pour 2 tablespoons of cloves half a liter of water, boil for 5 minutes. Strain the decoction, let it brew, apply to the sore spot 5 times a day for 30 minutes;
• birch buds are also useful. Pour 10 g of kidneys with 200 ml of boiling water. Insist for about an hour, strain. Compresses with this decoction perfectly relieve inflammation, and ingestion of a tablespoon 2 times a day helps to increase immunity;
• basil, St. John's wort, birch leaves. Mix all ingredients in equal proportions. Pour 1 tablespoon of the mixture with 300 ml of boiling water. Let it sit for an hour. Drink a decoction of 3 tablespoons 3-4 times a day.

The following tips will help you avoid bad luck:

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

Phlegmon is a disease that spreads rapidly, has a huge range of complications. If you let the course of the disease take its course, then a fatal outcome is inevitable. The infection spares no one. Follow safety rules, take preventive measures. Failed 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 the subcutaneous fat or cellular spaces. With phlegmon, the purulent process is not limited to one area, but spreads through the cellular spaces. This is a severe purulent process, the progression of which can lead to.

Table of contents:

Causes

Phlegmon develops when pathogenic microflora penetrates into the fiber. The causative agents are most often enterobacteria, E. coli.

First, there is a serous infiltration of fiber, 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. Purulent-necrotic process extends to adjacent tissues and organs. Changes in tissues depend on the pathogen. So, anaerobic infection entails necrotization of tissues with the appearance of gas bubbles, and coccal pathogens - purulent fusion of tissues.

Microorganisms invade adipose tissue by contact or hematogenous route. Among the most common causes of phlegmon are:

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

All phlegmons are divided into superficial (when subcutaneous tissue is affected up to the fascia) and deep (when deep cellular spaces are affected). The latter usually have separate names. So, inflammation of the perirectal tissue is commonly called, and the perirenal tissue is called paranephritis.

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

• Subcutaneous;
• Submucosal;
• Subfascial;
• Intermuscular;
• Retroperitoneal.

With superficial (subcutaneous) localization of phlegmon, severe pain, reddening 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. There is a symptom of fluctuation.

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

Deep phlegmon of the neck

The primary foci, which then become the source of neck phlegmon, 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 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, swelling of the skin is formed in the region of the sternocleidomastoid muscles, lower jaw, and chin. The swelling is initially dense, sometimes bumpy.

With superficial submandibular phlegmon in the chin area, the skin becomes red, swelling and soreness are observed. And with deep phlegmon, a very pronounced edema occurs in the region of the bottom of the mouth and lower jaw. Patients note a sharp soreness, which is aggravated by chewing.

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

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

Purulent mediastinitis usually develops rapidly, accompanied by fever, as well as pain behind the sternum, which spreads to the back, neck, epigastric region. There is swelling in the neck and chest. Patients, seeking to relieve pain, take a sitting position and try to keep their head tilted forward.

In addition, there is an increase in heart rate, a decrease in blood pressure, pain when swallowing and breathing, and expansion of the jugular veins.

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

The disease is characterized by diffuse pain in the limbs, fever, severe weakness. The onset of the disease is acute, rapid. There is swelling of the tissues, an increase in regional lymph nodes, the limb increases in size.

With a superficial location of phlegmon (for example, in the femoral triangle), hyperemia and swelling of the skin, a symptom of fluctuation, is observed.

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;
• Paracolitis;
• Phlegmon of the iliac fossa.

In the initial period of the disease, clinical signs are not clearly expressed. First, there are nonspecific symptoms of inflammation in the form of fever, weakness, headache. Local symptoms in the form of pain, swelling of tissues appear somewhat later. Localization of pain corresponds to the location of the purulent process. Often the doctor manages to palpate the inflammatory infiltrate through the anterior abdominal wall. Because of pain, a person will move with difficulty, therefore, to alleviate the condition, he tends to bend forward with an inclination to the sore side.

With phlegmon of the retroperitoneal space, a contracture of the thigh is formed - the adoption of a flexion position by the thigh with internal rotation and slight adduction. Psoas symptom occurs due to reflex contraction of the lumboiliac 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 perirectal space through the cracks of the posterior process, from inflamed hemorrhoids.

There are the following forms of paraproctitis:

1. Subcutaneous;
2. Ischiorectal;
3. Submucosal;
4. Pelviorectal;
5. Retrorectal.

Subcutaneous paraproctitis located in the anus. A person is worried about a sharp pain in this area, aggravated by defecation. Swelling and hyperemia of the skin are clearly defined. An increase in temperature is also recorded.

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

Ischiorectal paraproctitis runs more difficult. The purulent process captures the tissue of the ischiorectal cavities and pelvis. Patients feel throbbing pain in the rectum. It is noteworthy that edema 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 a person's illness, general symptoms are disturbing: weakness, fever. Then there is pain in the perineum and lower abdomen, frequent urination, stool retention, tenesmus.

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

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

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

The occurrence of phlegmon is also due to the presence of chronic diseases, excessive contamination of the skin with microorganisms,. So, obese people have highly developed subcutaneous fat, and when the drug is injected with short needles, it simply does not reach its final point - the gluteal muscle. Therefore, when injecting in such situations, the drug 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 present with fever and lymphadenitis.

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

With progressive phlegmon, surgical treatment should be carried out as early as possible. The operation takes place under general anesthesia. The surgeon performs an autopsy of phlegmon by dissecting the skin, subcutaneous tissue throughout.

After tissue dissection, pus is evacuated. Then the surgeon makes a revision of the purulent cavity and excision of necrotic tissues. For better drainage, additional incisions are made - counter-openings.

After the surgical manipulations, the wound is treated with 3% hydrogen peroxide, then it is tamponed with gauze soaked in an antiseptic.

In the postoperative period, wound dressings are regularly performed, and antibiotics are also prescribed.

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

Grigorova Valeria, medical commentator

Phlegmon is a purulent inflammation of soft tissues, characterized by a fairly rapid spread in the area of ​​\u200b\u200bmuscles, tendons and fiber, as well as soaking them with exudate. Phlegmon is characterized by localization in any part of the body, and with a neglected 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 multiply in conditions of complete absence of oxygen, can cause the development of a severe form of the disease.

What it is?

Phlegmon is an acute purulent inflammation of fatty tissue that does not have clear boundaries. 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

Phlegmon develops when pathogenic microflora penetrates into the fiber. The causative agents are most often staphylococci, streptococci, proteus, Pseudomonas aeruginosa, enterobacteria, E. coli.

First, there is a serous infiltration of fiber, 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. Purulent-necrotic process extends to adjacent tissues and organs. Changes in tissues depend on the pathogen. So, anaerobic infection entails necrotization of tissues with the appearance of gas bubbles, and coccal pathogens - purulent fusion of tissues.

Microorganisms invade adipose tissue by contact or hematogenous route. Among the most common causes of phlegmon are:

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

Types and locations of phlegmon

Taking into account the classification of phlegmon according to anatomical localization, the following types of pathology can be highlighted:

1. Serous - the initial form of phlegmonous inflammation. It is characterized by the formation of inflammatory exudate, as well as the intensive attraction of leukocytes to the pathological focus. At this stage, a palpable infiltrate appears, since the fiber is saturated with a cloudy gelatinous fluid. There is no clearly defined boundary between healthy and inflamed tissues. In the absence of timely prescribed treatment, there is a rapid transition to a purulent or putrefactive form. The development of one form or another is associated with causative microorganisms that have entered the entrance gate
2. Putrefactive - caused by anaerobic microorganisms that emit certain unpleasant odors in the course of their life. Affected tissues are brown or green in color, disintegrate in the form of a gelatinous mass and emit a fetid odor. This creates conditions for the rapid penetration of toxic substances into the systemic circulation with the development of severe intoxication, leading to failure of many organs.
3. Purulent - pathogenic microorganisms and enzymes secreted from phagocytes lead to the digestion of tissues and their necrosis, as well as purulent secretions. The latter represents dead leukocytes and bacteria, therefore it 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 human immune forces, the phlegmonous process spreads to muscles and bones, followed by their destruction. The main diagnostic sign at this stage is the absence of muscle bleeding with slight scraping.
4. Anaerobic. In this case, according to the morphological characteristics, the process is serous in nature, however, gas bubbles are released from the places of necrosis. Due to their presence in the tissues, a characteristic sign appears - slight crepitus. Hyperemia of the skin is slightly expressed, and the muscles have a "boiled" appearance.
5. Necrotic. It is characterized by the appearance of dead areas, which are clearly demarcated from healthy tissues. The border between them is a leukocyte shaft, from which a granulation barrier is subsequently formed, while necrotic areas can melt or be torn off. This delimitation leads to the formation of abscesses that are prone to self-opening.

The area of ​​occurrence of phlegmon may be different. 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 the phlegmon, it is divided into the following varieties:

1. Subfascial.
2. Subcutaneous, which progresses directly in the layer of subcutaneous fatty tissue.
3. Intermuscular, which is usually accompanied by current or progressive inflammatory processes in the muscle layer.
4. Perirenal, accompanied or caused by kidney diseases - this is how the pathogenic microflora penetrates into this area.
5. Retroperitoneal (phlegmon of the retroperitoneal space), which is detected by conducting a general examination of the abdominal cavity with frequent complaints of the patient about pain in the abdomen.
6. Near-rectal, located near the rectum and its origin is due to the penetration of pathogens through the walls of the rectum. The most common cause of phlegmon in this case is long-term constipation and instability of the intestines.

Since the main cause of the appearance of phlegmon should be considered the penetration of pathogens 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 develop rapidly. Patients have 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, drowsiness are observed. Nausea and vomiting often occur. Increased blood pressure, disturbed heart rhythms. The number of urination in the patient is reduced up to their complete cessation.

On the affected area there is a seal with swelling, hot to the touch, the skin is shiny. It is not possible to determine clear boundaries of education. There is a significant pain in this area, the lymph nodes located near the focus of inflammation are enlarged. With the further development of the disease, the compacted areas tend to soften, form purulent cavities, the filling of which sometimes breaks out on its own through the fistula or spreads further to neighboring tissues, provoking further inflammation and destruction.

The symptomatology of deep phlegmon is more pronounced and manifests itself in the early stages.

Phlegmon of the neck

Abscesses and phlegmon of the neck belong to the category of diseases, the course of which is unpredictable, and the consequences can be the most severe and even life-threatening for the patient. In most cases, the source of a pathogenic infection with neck phlegmon is inflammatory processes in the oral cavity and pharynx - chronic dental caries and similar diseases.

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

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

Phlegmon brush

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

Phlegmon of the face

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

Patients with suspected phlegmon of the face should be immediately hospitalized in a specialized medical facility (dental surgical department). In the absence of treatment for phlegmon of the face, 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 determine the disease in its initial stages. Characteristic swelling, redness "surrender" phlegmon. But purulent wounds, ulcers should be studied in order to understand the cause, the exact name of the infection. For this, ultrasound, tomograms, x-rays are performed. In difficult cases, resort to puncture, biopsy.

All these methods help to study the degree of development of the disease, to 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 stationary mode. Initially, it is necessary to eliminate pus, respectively, treatment begins with the evacuation of purulent exudate - opening and drainage. There is an excision of necrotic areas, as well as an additional opening and excision with the spread of pus. 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? Here, physiotherapy becomes effective:

1. Bandage according to Dubrovin (a compress with a yellow mercury mixture).
2. Dermoplasty.
3. UHF therapy.
4. Sollux lamp.
5. Warm compresses and heating pads.
6. infusion therapy.

Drugs that promote healing and rejection of dead tissue are actively used:

1. Painkillers.
2. Antibiotics.
3. Calcium chloride solution.
4. glucose solution.
5. Adonilen, caffeine and other drugs that improve cardiovascular performance.
6. Antigangrenous sera.
7. Urotropin solution.
8. proteolytic enzymes.
9. Ointment with enzymes - iruksol.
10. Sea buckthorn and rosehip oil.
11. Troxevasin.
12. Fortifying agents.
13. Immunomodulators.

At home, treatment is not carried out, so as not to provoke a chronic disease or the spread of pus. Drinking plenty of water and eating foods rich in vitamins acts as a diet. The patient complies with bed rest with an overestimation of the limb that is affected.

Complications of phlegmon

With untimely treatment, 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 arterial wall by microorganisms with the development of massive bleeding, which are very difficult to stop), secondary purulent streaks during the spread of the process.

Depending on the location of the phlegmon, specific complications are also isolated, 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 onset and development of the disease is 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 in a violent course, it can capture a number of anatomical regions, such as the thigh, buttocks and lumbar regions, the perineum, and the anterior abdominal wall. If phlegmon develops in the tissue surrounding a particular organ, then to refer to 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 perirenal tissue, paranephritis, inflammation of the pelvic tissue, etc.).

Phlegmon 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 due to 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 into the tissues, 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 occur very quickly.

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

The rapid spread of purulent inflammation in 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 intoxications (for example, alcohol), various immunodeficiency states, with the ability of microorganisms to multiply rapidly , release toxins, enzymes that destroy tissues.

Manifestations of phlegmon

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

Often there are forms that are malignant along the course, when the process progresses rapidly, capturing vast areas of subcutaneous, 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, saturated with a cloudy aqueous liquid, along the periphery, the inflammatory process without a clear boundary passes into unchanged tissue. With the progression of the process, the impregnation of soft tissues increases sharply, the liquid becomes purulent. The process can spread to muscles, tendons, bones. Muscles become gray in color, saturated with yellow-green pus, do not bleed.

putrid phlegmon , characterized by the development of multiple areas of necrosis in the tissue, tissue melting, copious purulent discharge, with a fetid odor.
For anaerobic phlegmon, widespread serous inflammation of soft tissues, extensive areas of necrosis (necrosis) and the formation of multiple gas bubbles in the tissues are characteristic.

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 weakly infectious microbes through the wound.

One of the types of chronic phlegmon is woody phlegmon (Reclus phlegmon) - the result of infection with microorganisms of the bottom of the mouth and oropharynx. It is characterized by the appearance of a painless, "hard as a board", infiltrate of the soft tissues of the neck.

Complications of phlegmon

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

Primary phlegmon can lead to a number of complications (lymphangitis, erysipelas, thrombophlebitis, sepsis, etc.). The spread of the process to the surrounding tissues leads to the development of purulent arthritis, tendovaginitis 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, it is necessary to conduct intensive intravenous infusion therapy, targeted antibiotic treatment, and immunomodulatory therapy.

What can you do?

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