Question from: Anonymous

There was a large painful swelling on the arm. A friend said that it looks like phlegmon, that the surgeon in the hospital will open it. I wouldn't want to go to the hospital. Tell me, what can be the treatment of phlegmon at home? Can, there are any compresses anesthetizing?

Answer: Doctor

Regardless of the form, putrefactive inflammation of the fiber is a very dangerous disease. It is not worth treating phlegmon at home on your own, so be sure to consult a doctor. All forms and stages this disease, except for the initial one, are treated by opening and draining purulent secretions while taking antibiotics.

After carrying out all the procedures and cleansing the wound, you can speed up the regeneration process with the help of traditional medicine. As a rule, poultices and compresses are used for this based on:

• Hypericum herbs;
• propolis;
• cloves;
• birch leaves or buds.

Recipe based on St. John's wort and propolis

It is necessary to take 50 g of St. John's wort, 25 g of propolis and 150 ml of vodka. Propolis should be finely ground and dissolved in vodka. Then add grass to the solution, close tightly and leave for a week. Shake the solution well daily.

After a week, strain the remedy. Add 50 drops of the composition to a glass of warm boiled water and apply to wash the outer area of ​​the wound 4-5 times a day. If phlegmon occurs in the oral cavity, this solution can be used for rinsing.

Decoction based on cloves

Stir a tablespoon of inflorescences in a glass of water and put on a slow fire. When the liquid boils, it must be kept on fire for another 3 minutes, then removed and let it brew for an hour. After that, strain the broth and use as a poultice on the affected area of ​​the skin. Can be taken orally 1 tbsp. l. three times a day.

Infusion on birch buds

Pour 10 g of birch buds with a glass of boiling water. Put the resulting solution on a slow fire and bring to a boil. Strain after 15 minutes. Apply as a poultice to the affected area and 1 tbsp. l. inside three times a day.

Decoction based on medicinal herbs

Mix 4 parts mint-leaf basil, 3 parts St. John's wort and 2 parts birch leaves. Steam a tablespoon of the collection with half a liter of boiling water and simmer over low heat for about 10 minutes. Then insist an hour under the lid. Drink the decoction should be filtered 30 ml 5 times a day.

Acute purulent inflammation of fatty tissues, rapidly spreading to the surrounding tissue, is called phlegmon.

FROM Greek the name of the disease is translated as "inflammation" or "fever". Phlegmon is one of the most dangerous diseases, characterized by the rapid spread of purulent masses in the intercellular spaces with the involvement of muscles and tendons. With an active course, it affects the anatomical regions. Untimely treatment threatens with a lethal outcome.

On a note. Inflammation can be both an independent manifestation and a complication caused by various purulent processes in the body.

Causes of inflammation, symptoms

Having penetrated through the blood or the affected skin, streptococci, staphylococci, Pseudomonas aeruginosa, pyogenic or other pathogenic microorganisms provoke the formation of purulent phlegmon.

The disease begins with the formation of an insignificant swollen area that has a red color. Touching it causes pain. As the tumor grows, there may be an increase in body temperature, perspiration, and inflammation of the lymph nodes.

Inflammation can appear on any part of the body where there are soft tissues. Neck phlegmon is of secondary origin. The initial infection originates in neighboring organs and penetrates further with the flow of lymph and blood. Where does the pathological process begin?

• boils, abrasions in the neck;
• caries;
• disease of the teeth or surrounding tissues;
• pulpitis;
• infectious diseases of the throat and trachea;
• inflammation of the cervical lymph nodes.

Common causes of facial phlegmon are usually such as teething wisdom or other problems with the teeth, as well as cysts and periodontitis. The chronic form is defined by a cyanotic color, soreness and a dense structure.

Important. The process of the course of the disease that has not been stopped in time leads to serious complications.

Phlegmon of the century is most often a complication of barley. Due to the mobility of the affected tissues, the inflammation proceeds painfully, causing inconvenience when blinking. In addition, the formed seal has a mechanical effect on the eyeball, causing additional pain and profuse lacrimation.

A complication of the advanced form of panaritium can be phlegmon of the hand, which usually spreads along the tendons of the extreme fingers. Often there are inflammation and other fingers. The type of inflammation depends on the location of purulent-necrotic accumulations:

• inflammation of the palmar surface;
• back surface.

The phlegmon of the thigh does not develop on the surface. This localization site is characterized by development in the depth of the muscles. Education can appear both by itself and as a result of pus from neighboring areas (hip joint, abdominal wall). Diagnosis is not difficult, since the diameter of the affected hip is much larger than the healthy one. On palpation, acute pain is felt.

Good to know. Phlegmon spreads deep into the tissues, touching the dermis and subcutaneous tissue. It is the boundless spread of inflammation to the sides and into the deep layers of loose spaces that distinguishes soft tissue phlegmon from superficial skin ailments.

The division into types occurs on several grounds:

• by type of pathogen;
• according to the structure of the nosological unit;
• depending on the localization of purulent inflammation.

Although microorganisms are the main cause of the development of the disease, the penetration of infection does not necessarily threaten the formation of phlegmon. Whether an inflammatory process appears or not depends on several factors, such as:

• the state of the immune system;
• the number of microorganisms that have entered the wound, and their resistance to drugs;
• characteristics of the lesion;
• state of local and systemic circulation;
• the presence of allergic reactions.

Remember. Frequent use of antibiotics weakens the body's resistance, the risk of developing purulent inflammatory diseases rises.

If the body temperature rises to high levels, the patient is thirsty and muscle weakness. Purulent phlegmon becomes dense, hot. Due to severe pain, the diseased limb may cease to function. After a few days, the exudate is separated.

Important. Diagnosis at an early stage makes it easier to determine the severity of inflammation and prescribe the correct treatment.

A patient with suspected phlegmon is sent to a hospital, where, depending on the nature of the purulent formation, complex therapy is performed.

Traditional measures to combat the disease

The main treatment of phlegmon, abscesses and similar purulent formations is performed surgically. The purulent focus is widely opened, the outflow of its contents is made. The intervention takes place in such a way as to reduce the risk of cosmetic defects. The patient is given local anesthesia or general anesthesia, depending on the complexity of the operation.

Together with surgical excision antibiotics are prescribed, regular compresses and dressings are applied. In order to reduce intoxication, antihistamines are prescribed.

At an early stage of inflammation, until purulent fusion of tissues has occurred, conservative therapy is practiced.. Since drainage is not required, the following measures are taken:

• prescribing antibiotics;
• dressings containing alcohol;
• use baths with antiseptics (if the affected area allows it);
• introduction of novocaine solution into the focus;
• physiotherapy procedures.

Since phlegmon is an inflammatory process, anti-inflammatory compresses are required for resorption (Vishnevsky ointment, half-alcohol solutions, herbal decoctions). Dressings are recommended to be applied before going to bed, and in daytime add physical therapy. In the treatment of phlegmon, a combination of UVI with UHF is successfully used.

Important. Treatment of phlegmon at home requires great care, since this disease is very serious. Any prescription must be coordinated with the doctor.

homemade recipes

Before starting the procedures, you should understand what phlegmon is in order to treat it correctly and effectively.

Important. Since the disease is inflammatory, the first step is to determine the amount of sugar in the blood. Patients suffering from a disorder carbohydrate metabolism tolerate treatment much harder. Important condition for diabetics - the sugar content should be normal.

Recipes:

1. A proven remedy is the mummy, which is available both in tablets and in raw form. The drug can be purchased at a pharmacy. 1 g of mountain wax must be dissolved in a glass hot water and place in a cold place. You need to take 1 tbsp. l. twice a day before meals.
2. In the physiotherapy room, you can do electrophoresis using the same tool. The resin is applied to the diseased area and penetrates into the tissues with the help of an electric current.
3. Take in equal proportions galangal, plantain, elecampane, calendula, comfrey, calamus, birch leaves, marshmallow root, sweet clover. 2 tbsp. l. pour 400 ml of hot water and boil for 10 minutes. After 2 hours, strain and take 2 tbsp. l. per day. Adding honey is allowed. The course of admission is 10 days.
4. 2 tbsp. l. pour eucalyptus into a thermos and pour boiling water (300 ml). After a few hours, add some water and drink a third of a glass before meals.
5. You need to purchase 100 g of St. John's wort, 50 g of propolis, 300 ml of vodka. To prepare the infusion, add vodka and St. John's wort to crushed propolis. After the composition has been infused for a week in a cold and dark place, it must be filtered and lotions made.
6. Crush 300 g of fresh currant berries and consume during the day in 3 doses. Adding honey or sugar is allowed.
7. 3 art. l. cloves pour 1 liter of water for 1 hour. Ready solution use for compresses.
8. Mix chopped burdock leaves with sour cream in a ratio of 2:1. Apply the mixture on the affected area for 30 minutes.
9. Mix skin powder with flour, apply the powder to the affected area and leave overnight. To increase efficiency, add 3 g boric acid, 8 g of white streptocide, 12 g of xeroform and 30 g of sugar.

Professional treatment with antibiotics is required to completely get rid of the disease. ethnoscience is only an addition to the main treatment.

Preventive measures

The main task of preventing the formation and spread of the disease is to prevent injuries. In the event of even a microtrauma, it is necessary to provide the first medical care. All existing infectious foci should be eliminated in a timely manner.

Despite active implementation in clinical practice new groups of antibiotics, the problem of prevention and treatment of purulent-septic complications in surgery is still relevant. So, according to the literature data, the frequency of purulent-inflammatory complications after hernia repair reaches 28.3%, after resections of the stomach - 28.4%, cholecystectomy - 32%, appendectomy - 40.4%, pancreatitis - 50% (Priskar V.I. , 1999).

Mortality in peritonitis ranges from 16 to 80% (Datsenko B. M. et al., 1998, Gelfand B. M. et al., 1999, Kamzakova N. I., 2000).

In the structure of nosocomial infections, postoperative infections account for 12.2%, and post-injection infections - 17%. It should be noted that the percentage severe consequences nosocomial infections is almost the same for surgical hospitals and outpatient clinics - 15.2% and 15.6%, respectively.

Of particular concern are cases of belated diagnosis of a complicated course of abscesses or phlegmon. So, for example, depending on the localization of the primary purulent process, severe purulent arthritis can form (after intra-articular administration of hormonal, analgesic drugs), thrombophlebitis (after intravascular administration of various drugs) with subsequent generalization infectious process, with the formation of purulent foci in the internal organs (in the heart, lungs, kidneys).

A retrospective analysis of severe abscesses and phlegmons complicated by sepsis after a long conservative or insufficiently active surgical intervention shows that one of the main causes of complications can be considered insufficient attention to the early diagnosis of emerging abscesses and phlegmons of various localization, which involves the use of modern non-invasive research methods (ultrasound, computed tomography), as well as invasive diagnostic methods, and above all diagnostic puncture of the infiltrate area. Of particular concern is the so-called expectant tactics, when, after performing a diagnostic puncture and removing a certain amount of pus, surgeons try to drain the purulent cavity with a rubber tube and prescribe some antibacterial drug.

Radical surgical interventions on an already formed purulent focus, they are performed too late, drainage of the postoperative wound is, as a rule, inadequate.

In addition, due attention is not paid to the problem of asepsis and antisepsis in providing assistance to victims, as well as in performing various diagnostic and therapeutic procedures, both at the outpatient and inpatient stages of treatment. The use of traditional antiseptics in these situations, unfortunately, does not prevent the development of an infectious process, since the problem of microorganism resistance in equally relevant for both the group of antibacterial drugs and traditional antiseptics.

For example, sensitivity S.aureus, E.coli, B.fragilis to a solution of furacillin is less than 3, 1 and 3%, respectively. The massive contamination of P.aeruginosa in furacillin solution can reach 106 CFU/ml. The frequency of contamination of furacillin solution with fungi reaches 58%.

As can be seen from Table. 2, in the overwhelming majority of cases, gram-positive microflora was isolated from wounds, and in isolated cases, an association of gram-positive and gram-negative microorganisms was isolated. A rather large number of cases of detection of non-clostridial anaerobic infection in wounds attracts attention.

Rice. four

All strains isolated from postoperative wounds of patients previously operated in other medical institutions were multiresistant to traditionally used antibacterial drugs, which indicates the hospital affiliation of the infection.

Taking into account the species nature of the microflora isolated from the wounds and its sensitivity to antibacterial drugs, general and local antibacterial therapy was prescribed.

Most often (38.5%), semi-synthetic penicillins (carbenicillin, ampiox, dicloxacillin) were used, in 15.7% of cases - aminoglycosides (gentamicin, tobramycin, sisomycin, netilmicin), in 12.5% ​​- fluoroquinolones (ofloxacin, pefloxacin, ciprofloxan). ), in 10.3% - cephalosporins (cefotaxime, ceftazidime, ceftriaxone).

When a purulent-inflammatory process caused by a non-clostridial anaerobic infection was detected (27 patients - 16.3%), as a rule, combined antibiotic therapy was prescribed - metronidazole with gentamicin or netilmicin or clindamycin with gentamicin or netilmicin. AT last years in similar situations The drug of choice is imipenem, which allows you to actively influence both the aerobic and anaerobic components of the microflora of wounds. With a local purulent process, in case of detection of sensitivity of staphylococci to fusidine, the appointment of this drug in complex treatment was also justified.

Selection of antiseptics used for washing wounds

As already mentioned, the use of furacillin solution is currently impractical due to its extremely low antimicrobial activity. At present, solutions of dioxidine, miramistin, furagin soluble can be considered promising.

First of all, it is very important to monitor the cleanliness of not only the wound itself, but also the skin surrounding the wound.

When choosing skin antiseptics used both prophylactically and therapeutic purpose, preference is given to drugs with a universal, broad or moderate spectrum of action, active against mixed microflora and having a microbicidal or microbostatic effect.

Iodine preparations are still very popular among medical workers. They have an almost universal spectrum of activity: they inhibit gram-positive bacteria, including enterococci and mycobacteria, gram-negative bacteria, including Pseudomonas, acinetobacteria, Klebsiella, Proteus, bacterial spores, fungi, viruses, including hepatitis B and C viruses, entero- and adenoviruses, and also anaerobic, spore-forming and asporogenic bacteria.

1% iodovidone, 1% iodopyrone - iodophors, which are a complex of polyvinylpyrrolidone with iodine. Differences between these drugs are associated with the method of their preparation, as well as different molecular weights of polyvinylpyrrolidone. Iodovidone solutions are more stable during storage than iodopyrone solutions, which are usually prepared ex tempore. According to the degree of bactericidal action, these drugs are almost identical.

Sulodopyrone is a foamy liquid that is intended for washing dirty infected wounds, treating wounds under a bandage, cleaning the hands of a surgeon and operating field. Suliodopirone, when applied topically, has a bactericidal effect.

The bactericidal effect with a microbial load of 106-107 bacteria per 1 ml of the medium occurs within 1-4 minutes, surpassing the iodopyrone solutions in these indicators.

1% dioxidine has a pronounced activity against most aerobic, anaerobic and facultative anaerobic pathogenic bacteria.

Clinical strains of bacteria with multiple resistance to antibiotics are sensitive to dioxidin. The drug is used for washing and plugging purulent wounds, and can also be administered intravenously, intraarterially, intratracheally through a catheter or inhalation, intrapleurally, into the abdominal cavity through irrigators.

Our 20-year experience in the use of dioxidine in the complex treatment of patients with sepsis, peritonitis, mediastinitis, with an extensive clinical picture of intoxication, progressive multiple organ failure does not confirm the opinion of some experts about the high toxicity of this drug. Strict compliance rules of administration, single, daily and course doses avoids such undesirable side effects as nausea, vomiting or convulsions.

0.1% furagin (solafur) - antimicrobial agent from the group of nitrofurans. The drug mainly acts on gram-positive microflora. Its IPC is 10-20 times lower than that of furacillin. It is used either intravenously in severe forms of the course of a wound infection, in an infectious process in the lungs, urinary tract organs, or locally in the form of a 0.1% solution in the treatment of wounds infected with staphylococci, as well as for washing the bladder.

0.01% miramistin (myristachloride) is a new antiseptic from the group of cationic surfactants.

Miramistin is characterized by a wide range of antimicrobial properties. The drug has a detrimental effect on gram-positive, gram-negative bacteria, fungi, viruses, protozoa, aerobic and anaerobic, spore-forming and asporogenic microorganisms in the form of monocultures and microbial associations, including hospital strains with polyresistance to medicines.

0.01% water solution miramistin with a preventive and therapeutic purpose is used in surgery, traumatology and combustiology with a small amount of purulent discharge in the wound. The surface of wounds and burns is irrigated with the drug, wounds and fistulous passages are loosely plugged, gauze swabs moistened with an antiseptic, the abdominal cavity is washed, injected into the pleural cavity and bladder.

With abundant purulent exudation the use of gauze swabs with antiseptic solutions for local treatment of wounds is unjustified, since swabs placed in the wound dry out quickly and, therefore, do not have the long-term osmotic activity necessary to remove pus. In extreme cases, the wound can be filled with a combined tampon - a silicone tube is placed in the center of the gauze tampon, through which 10-20 ml of antiseptic is injected into the wound with a syringe 2-3 times a day. Instead of a 10% sodium chloride solution for packing postoperative wounds, modern water-soluble ointments are currently used, the high clinical significance of which can be considered proven.

Possibilities of using ointments

Unfortunately, a number of clinics still use fat-based ointments with antibiotics: syntomycin liniment, tetracycline, erythromycin, etc. However, fat-based ointments with antibiotics have only a short-term effect, since the vaseline-lanolin base disrupts the outflow of wound discharge, does not sufficient release of the active ingredient from the composition does not contribute to the penetration of the antibiotic into the depths of the tissues where microbes are located, which leads to the transition of acute inflammatory diseases to chronic ones. Due to the formation of highly resistant strains of microorganisms in hospitals, both ichthyol ointment and Vishnevsky ointment have almost completely lost their clinical significance.

In recent years, new ointments based on polyethylene oxide (combinations of polyethylene oxides with a molecular weight of 400 and 1500) have been introduced into clinical practice for the treatment of purulent wounds in the first phase of the wound process.

Polyethylene oxides are derivatives of ethylene oxide and have low toxicity and pronounced osmotic properties. When creating drugs for the treatment of purulent wounds, polyethylene oxide with a molecular weight of 400 (PEO-400) and polyethylene oxide with a molecular weight of 1500 (PEO-1500) are most often used.

In a purulent wound, PEG-1500 actively binds the inflammatory exudate, giving it to the bandage, with which the liquid evaporates, and the released PEG-1500 molecules reattach the exudate that accumulates at the bottom of the wound.

Smaller molecules (PEG-400) are able to penetrate deep into tissues. Forming a complex with the antibiotic, PEG-400 conducts it into the wound tissue, where microbes are localized. In this it is fundamentally different from ointments based on lanolin-vaseline, which are able to have an antimicrobial effect only for a short time and only on the surface of the wound.

Various antimicrobial preparations have been introduced into the composition of modern polyethylene oxide-based ointments:

• chloramphenicol (levomycetin, which has not only antibacterial and anti-inflammatory effects, but also due to its constituent methyluracil and trimecaine, regenerating, necrolytic and analgesic effects, which greatly alleviates the patient's condition);
• dioxidine (5% dioxidine new ointment, dioxycol, methyldioxilin);
• iodine with polyvinyl pyrrolidone (1% iodopyrone ointment, iodometrixide);
• metronidazole + chloramphenicol (metrocaine);
• nitazol (streptonitol, nitacid);
• furacillin (furagel);
• quinifuril (0.5% quinifuril ointment);
• mafenide acetate (10% mafenide acetate ointment).

In addition, drugs such as trimecaine, which has an analgesic effect, and methyluracil, which has anabolic and anti-catabolic activity, have been introduced into the composition of ointments in order to stimulate cell regeneration processes.

All PEO-based ointments differ from traditional preparations primarily in their multidirectional action - the osmotic effect is observed up to 18 hours, which allows dressings to be done only once a day, while when using 10% sodium chloride, repeated dressings must be performed every 3 -4 hours, otherwise the dressing soaked in solution and wound discharge completely loses its osmotic ability.

Another advantage of polyethylene oxide-based ointments is wide range antimicrobial activity.

Moreover, in terms of the effectiveness of the impact, due to the uniformity of the ointment base, all ointments are practically equivalent. When creating new ointments, special attention was paid to their antibacterial activity. A.V. Vishnevsky wrote about this: “We are interested in the strength, the degree of bactericidal properties of the ointment, because reducing, knocking down, destroying the infection in the wound is always a necessary and grateful task” (Vishnevsky A.V., 1937).

The antimicrobial activity of new ointments against S.aureus is at the level of 86-97.3%, E. coil - 71-97%, P.aeruginosa - 64-90.8%, Proteus spp. - 76-100%.

To suppress gram-negative bacteria in wounds, in particular Pseudomonas aeruginosa, a 10% hydrophilic mafenide-acetate ointment is widely used.

Despite the intensive use of ointments containing levomycetin or dioxidine, their high antimicrobial activity persists for more than 20 years, which indicates a weak process of increasing resistance of hospital strains.

With the introduction of a polyethylene glycol base into the technology for creating new dosage forms, it became possible to create ointments with nitrofuran compounds. Based on them, two ointments are produced: 0.5% quinifuril ointment, as well as furagel, where an acrylic acid copolymer (SOKAP) and PEG-400 is used as the base.

New domestic ointments containing nitrofuran compounds show high clinical and bacteriological efficacy. So, furagel is more active (94%) in the presence of S.aureus in the wound and less active (79%) in P.aeruginosa. Quinifuril ointment is equally highly active in the presence of gram-positive and gram-negative microflora in the wound (87-88%). Both drugs are well tolerated even in the case of their long-term use in the treatment of trophic ulcers. The use of a copolymer of acrylic acid with polyethylene glycol in various weight ratios as an ointment base makes it possible to regulate the osmotic activity of the ointment both in the direction of its increase and decrease, which is very important when the wound process passes into the second phase and the need to continue wound treatment under a bandage.

The clinical efficacy of 1% iodopyrone ointment and multicomponent iodine-containing ointment (iodine metricsilene) as a therapeutic agent is 92.6-93.4%. The bacteriological activity of these two drugs was equally high (91.8-92.6%) against all major pathogens of acute purulent processes of soft tissues. Side effects (clinically significant) were observed in 0.7% of cases and clinically insignificant - in 2.3% of cases. It should be emphasized high efficiency these drugs in the treatment of wounds with fungal infection, which is often observed in debilitated patients, with extensive burn wounds, trophic ulcers, bedsores.

Currently, only foreign iodine-containing ointments (povidone-iodine and betadine) have been introduced into clinical practice, although the domestic analogue was developed more than ten years ago.

It has been established that the level of contamination of wounds with aerobic microflora during the treatment with PEG-based ointments falls “below critical” by the 3-5th day. The appearance of granulations on average is achieved by the 4th day, the beginning of epithelialization - by the 5th.

A wide range of antimicrobial activity of polyethylene glycol-based ointments, their high and long-term osmotic activity make it possible in more than 80% of cases to stop acute pain within 4-5 days. purulent process and complete the treatment of uncomplicated purulent wounds of soft tissues by applying primary delayed sutures, while when using a hypertonic solution of sodium chloride in 90% of cases only at the end of the 2-3rd week of treatment under the cover of systemic antibiotic therapy it is possible to close the wound by applying secondary sutures.

For the treatment of non-sporogenic anaerobic infections, along with dioxidine, promising opportunities opened up after studying the drug nitazol, which showed a high antibacterial effect on staphylococci, streptococci, E. coli, aerobic spore-forming bacteria, pathogenic anaerobic microorganisms, both clostridial and non-clostridial in the form of monocultures and microbial associations. According to the spectrum of antibacterial action, nitazol has advantages over metronidazole, to which staphylococci, Escherichia coli, streptococci are insensitive. Nitazol has an anti-inflammatory effect, being a non-steroidal anti-inflammatory agent.

On the basis of nitazol, a foaming aerosol "Nitazol" and two multicomponent ointments "Streptonitol" and "Nitacid" were created. In terms of antimicrobial activity, streptonitol and nitacid are significantly superior to the foreign drug "Klion" (Hungary), which includes metronidazole. The osmotic activity of streptonitol is much lower than that of nitacid, which is due to the introduction of vaseline oil with water into its composition. Both streptonitol and nitacid, created for the treatment of wounds with non-clostridial anaerobic infection, have an equivalent wide spectrum of antimicrobial activity against both gram-positive and gram-negative microflora (84.2-88.5%). Attention is drawn to the high activity of these drugs in the presence of P. aeruginosa in the wound (86.3-91.1%). Both positions show good clinical efficacy in the presence of anaerobic infection in the wound (88-89%).

The difference in osmotic activity allows the use of these drugs in steps - first nitacid (with high osmotic activity), then streptonitol.

Specialists involved in the treatment of purulent wounds are well aware that there are situations when one scalpel is not enough to completely remove necrotic tissues: proteolytic drugs are needed.

At present, the high clinical efficacy of the complex enzyme preparation "Protogentin" has been proven, containing the enzyme of natural origin "protease C" with a proteolytic effect, antibiotics (gentamicin and erythromycin), preservatives.

The ointment base of the drug consists of polyethylene oxide with vaseline oil. Moderate osmotic activity ensures the removal of pus from the wound.

Protogentin, the most active against P. aeruginosa and E. coli, inhibits the growth of 83.4-90.4% of strains.

The antimicrobial components of the Protogentin ointment penetrate well under the wound scab, as a result of which concentrations are created in the wound tissues that are much higher than the MIC.

Sufficient osmotic activity, a wide range of antimicrobial activity, good pharmacokinetic properties of protogentin help to reduce the time of necrolysis. The ointment base does not damage the granulation tissue, which allows the use of this drug for a long time, while enzymatic cleaning of the wound surface is required.

After cleansing the wound from purulent-necrotic contents and achieving its bacteriological sanitation, the second phase of the wound process begins. This period is characterized by the appearance of islets in the wound. granulation tissue, which, developing, covers the wound surface completely. Healthy granulation tissue is always bright, juicy, and bleeds easily. At the slightest deterioration in the processes of biosynthesis in the wound, the appearance of granulations changes: they lose their bright color, become small, and become covered with a mucous coating. One of the reasons for this complication is superinfection. Any slowdown in the development of granulations leads to a delay and stop the process of epithelialization.

Of great importance for the speedy healing of wounds in the second phase is the ability of drugs used for local treatment to have a bactericidal effect in order to prevent secondary infection, protect granulation tissue from mechanical damage, and also have a moderate moisture-absorbing effect and stimulate the growth of granulations.

The best option is a combination of these factors in one preparation. These drugs include modern combined ointments on an adjustable osmotic basis: methyldioxilin, streptonitol, as well as foam aerosols "Suljodovizol", "Gipozol-AN", wound dressings based on sodium-calcium salt of alginic acid, oils, aerosols, hydrocolloid coatings ().

Ointment "Methyldioxilin" - a multicomponent ointment, contains dioxidine, methyluracil and a hydrophobic emulsion base with the presence castor oil. The composition of vinylin with an emulsifier and PEG-400 as the base of the ointment made it possible to reduce the osmotic activity of this preparation to such a level that the new ointment would not overdry the young granulation tissue.

Ointment "Streptonitol" contains antibacterial substances streptocide and nitazol on a hydrophilic emulsion basis, which has a weak osmotic effect, removing excess moisture, and at the same time protects the granulation tissue from mechanical damage. The drug is indicated for the treatment in the second phase of inflammation of wounds previously infected with anaerobic, gram-positive and gram-negative microflora in the presence of bright juicy granulations.

Aerosols

At the transitional stage of the first phase of the wound process to the second, modern foam and film-forming aerosols show high clinical efficiency. Foam preparations in aerosol packaging are promising for prevention and treatment purulent complications. This is due to the fact that foams create a barrier to infection of wounds, they do not have " greenhouse effect»; a small amount of the drug in the composition of the foam can cover large wound surfaces and fill volumetric wound channels and "pockets". The advantage of the aerosol form is the speed of processing, which is important in the event of a mass influx of victims. Foam applications are atraumatic.

Currently, a number of foam preparations have been created:

• dioxysol (dioxidine);
• Suliodovizole (iodovidone);
• sulodopyrone (yodopyrone);
• nitazol (nitazol);
• cimesol (ciminal + trimecaine + oxidized cellulose powder);
• hypozol-AN (nitazol + aekol + methyluracil).

The composition of modern foam preparations necessarily includes some kind of antimicrobial agent that acts on aerobic or anaerobic microflora, including non-clostridial (bacteroids, peptococci, peptostreptococci). The most commonly used are dioxidin, iodovidone, cyminal and nitazol. Studies of the antibacterial properties of these drugs on models of purulent wounds caused by anaerobic infection show a pronounced therapeutic effect, which consists in reducing the seeding of bacteria from wounds by the 3-5th day of treatment to 10 1-2 microbes per 1 g of tissue, reducing swelling and hyperemia, cessation of purulent exudation and further in wound healing.

Cimesol, in addition to the antiseptic cyminal, contains the anesthetic trimecaine and hemostatic - oxidized cellulose powder. The antiseptic effect of cyminal is enhanced by the combination with dimexide and 1,2-propylene glycol, which ensure the penetration of cyminal into necrosis zones and a moderate osmotic effect.

Dioxysol is prepared on a high osmotic basis, and the dehydrating effect of dioxyplast is reduced to a minimum. This determines their use, respectively, in the first and second phases of the wound process in the absence of wounds a large number purulent discharge. The study of the antimicrobial activity of the new dioxysol aerosol showed the advantage of this drug in case of detection of gram-negative microflora in wounds. Dioxysol suppresses Ps. aeruginosa at 92.5%.

Suliodovizol is a foaming aerosol preparation that expands the possibilities of treating wounds with iodovidone in surgery. The drug is indicated for the treatment of wounds in the second phase of the wound process, previously infected with gram-positive and gram-negative aerobic microflora.

Wide clinical researches showed the need to use foaming aerosols only in the absence of a pronounced purulent-inflammatory process at the stages of preparing the wound for its closure with sutures or plastic surgery.

Oils

Currently, various oils are widely used for the treatment of wounds, including those of plant origin (sea buckthorn oil, rosehip oil, millet oil - miliacil). The first publications on the application for this purpose various oils belong to the Renaissance (Giovanni de Vigo, 1460-1520, Ambroslse Pare, 1510-1590).

Comparative experimental studies have shown that millet oil primarily has a wider antimicrobial spectrum actions compared to rosehip or sea buckthorn oil.

Millet oil (miliacil) has a high acid number (151.5-178.3), due to the high content of free, unsaturated fatty acids (oleic, linoleic, linolenic). This explains the sterility of the drug and its sufficient antimicrobial effect. In addition, a complex steroid compound, a pentacyclic triterpenoid, miliacin, which is part of millet oil, has an anabolic effect and is a membrane stabilizer. By stabilizing lysosomal membranes, miliacin protects them from the action of membrane-damaging factors, such as toxins. In this regard, the activity of cathepsins, acidic RNases and DNases decreases, which leads to a decrease in tissue exudation, hypoxia, and depolarization of RNA and DNA.

Wound dressings

Wide opportunities in the local medical treatment of wounds opened up with the advent of various wound dressings with such valuable qualities as antimicrobial activity, the ability to reliably prevent reinfection of the wound surface, the ability to provide local hemostasis, accelerate the formation of granulations, epidermis and actively absorb wound exudate. In addition, modern wound dressings actively stimulate the formation of granulations and epidermis. When changing dressings, these drugs do not cause pain. With a long stay of wound coverings on the wound, there is no unpleasant odor.

In order to stimulate regeneration processes in the wound, dressings based on protein and polysaccharide derivatives are most widely used. Taking into account the specific effect of collagen compounds on reparative processes in the wound, as well as data on the effectiveness of polysaccharide compounds in terms of creating optimal conditions for the formation of granulation tissue and migration of epithelial cells, wound dressings based on protein-polysaccharide complexes and their compositions with drugs have been developed. Vegetable polysaccharide (sodium alginate) and animal polysaccharide (chitosan) were used as polysaccharide compounds.

Biologically active stimulating wound dressings

Biologically active stimulating wound dressings with antimicrobial and local anesthetic action are available in four versions:

• digispon A (collagen + gelevin + dioxidine + anilocaine);
• algicol-FA (collagen + alginate + furagin + anilocaine);
• collachite-FA (collagen + chitosan + furagin + anilocaine);
• anishispon (collagen + shikonin).

These wound dressings have a beneficial effect on the course of regenerative processes in the wound. Collagen-alginate coatings stimulate the growth of granulation tissue, and collagen-chitosan coatings stimulate the growth of epithelial cells.

In recent years, preparations based on alginic acid and collagen have received the greatest distribution.

Based on mixed sodium-calcium alginic acid, polyfunctional moisture-absorbing preparations for local treatment of wounds in the second phase (algipor, algimaf) were created.

Stimulating wound dressings are well modeled on various parts of the body, provide normal vapor exchange in the wound, absorb excess wound exudate, have a prolonged antimicrobial and analgesic effect, and create a moist environment that is optimal for epithelial cell migration. The release of drugs from stimulating wound dressings is carried out within 48-72 hours, depending on the amount of wound exudate in the wound.

All modern wound dressings have high antimicrobial activity due to the antimicrobial components introduced into them (sizomycin - in siproline, mafenide acetate - in algimafe, furagin - in algicol ACF and collachite FA).

Comparative evaluation of the antibacterial activity of these drugs shows that the elimination of S.aureus, Proteus spp. from wounds occurs faster when using algimaf and siproline.

Hydrocolloids

In recent years, for the treatment of patients with long-term non-healing wounds, trophic ulcers, bedsores, hydrocolloid drugs have been used abroad, in particular those containing pectin - duoderm (USA), varigesiv (USA).

In NPO "Biotechnology" (Russia) together with the Institute of Surgery. A. V. Vishnevsky RAMS developed two hydrocolloid dosage forms a new generation based on pectin: galacton is a liquid hydrocolloid intended for the treatment of long-term non-healing deep wounds of soft tissues with a moderate amount of purulent discharge; galagran - dry hydrocolloid (powder) for the treatment superficial wounds soft tissues, bedsores, trophic ulcers.

Due to the addition of dioxidine, hydrocolloids show better activity compared with other drugs against P. auruginosa.

When comparing hydrocolloids (galagran and galacton) with sorbents (dezhizan and debrizan), a wider range of positive properties hydrocolloids. First of all, hydrocolloids stimulate the processes of regeneration and epithelialization, prevent reinfection of the wound surface, maintain a moist environment under the bandage. The indicator of the sorption capacity of galagran is low: for water - 3.56 g / g, for blood - 2.57 g / g; at the same time, the upper layer of galagran is not wetted by model liquids throughout the entire observation period (one day).

The main absorption of water occurs within 5 hours, then a decrease in the amount of sorbed liquid is observed due to the drying of the upper layer and the formation of a crust, which complicates the drainage process. Galagran particles in the contact layer swell, turning into a gel-like mass, which spreads evenly over the wound.

According to the cytological study, in the first three days of using galagran in wound prints, a tendency to intensive formation of granulation tissue is revealed.

Given the nature of the biopolymer, hydrocolloids (galagran and galacton) should be used at the stage of development of reparative processes in the wound.

Gentacyclo

A highly effective drug for the treatment of long-term non-healing wounds, trophic ulcers, osteomyelitis, and diabetic foot is gentatsycol, a prolonged form of gentamicin on a biodegradable (collagen) basis.

Prolonged and high concentrations of gentamicin are found when using gentatsycol in the treatment of osteomyelitis or in cases of definitive closure of the osteomyelitis cavity with sutures.

Gentacicol creates high concentrations of gentamicin in the wound tissues for 2 weeks, and these concentrations are much higher than the MICs of the main pathogens of surgical infection.

Biodegradable collagen sponge with gentamicin contributes to the relief of the infectious process, activates the proliferation of all cellular elements of the granulation tissue, enhances collagenogenesis. The drug can be used in urgent surgery as a local hemostatic agent. The use of gentatsykol in the complex treatment of various wounds can reduce the indications for general antibiotic therapy from 16.6 to 5.5%; at the same time, in 98.2% of cases, early reconstructive skin plastic surgery is successful.

Literature

1. Wounds and wound infection / Ed. M. I. Kuzina, B. M. Kostyuchenko. M.: Medicine, 1990. S. 591.
2. Theory and practice of local treatment of purulent wounds / Ed. B. M. Datsenko. Kyiv: Health, 1995. S. 383.
3. Glyantsev S. P. Development of modern enzyme-containing dressings and improvement of methods for their use in the complex treatment of purulent wounds / Clinical and experimental study: Dis. ... doc. honey. Sciences, 1993.
4. Kuzin M. I., Kostyuchenok B. M., Karlov V. A., Kolker I. I., Belotsky S. M., Svetukhin A. M., Blatun L. A. et al. General principles of treatment of purulent wounds: Guidelines. M., 1985.
5. Kuzin M. I., Kostyuchenko B. M., Datsenko B. M., Pertsev I. M., Blatun L. A., Belov S. G., Kalinichenko V. N., Tamm T. I. Local drug treatment Purulent wounds: Guidelines. M., 1985.
6. Kuzin M. I., Kostyuchenok B. I., Vishnevsky A. A., Kolker I. I., Shimkevich L. L., Kuleshov S. E., Borisova O. K., Istratov V. G., Blatun L. A. et al. Anaerobic non-clostridial infection in surgery: Guidelines. M., 1987.
7. Kostyuchenok B. M., Karlov V. A., Medetbekov I. M. Active surgical treatment of a purulent wound. Nukus: Karakalpakstan, 1981. 205 p.
8. Sopuev A. A. Evaluation of the effectiveness of draining sorbents and biologically active compositions based on them in the complex treatment of purulent wounds: Abstract of the thesis. cand. honey. Sciences, 1989.
9. Local medical treatment of wounds: Proceedings of the All-Union Conference. M., 1991.
10. Grigoryan S.Kh. Comparative efficacy and specificity of the use of sorbents and biologically active compositions based on them in the complex treatment of purulent wounds. Clinical and experimental study: Abstract of the thesis. doc. honey. Sciences. M., 1991.
11. I International Conference "Modern Approaches to the Development of Effective Dressings and Polymer Implants": Proceedings of the I International Conference. M., 1992.
12. Muradyan R.G. The effectiveness of biologically active compositions based on gelevin in the complex treatment of wounds: Experimental clinical study: Abstract of the thesis. cand. honey. Sciences. M., 1992.
13. Muradyan R. G. Modern methods local treatment of wounds, stimulating reparative processes: Experimental clinical study: Abstract of the thesis. diss. ... doc. honey. Sciences. M., 1996.
14. Dobysh S.V. Development and study of a new generation of dressings based on modified polymeric materials: Abstract of the thesis. dis. ... doc. honey. Sciences. M., 1999.
15. Adamyan A. A., Dobysh S. V., Kilimchuk L. E., Goryunov S. V., Efimenko N. A. et al. Biologically active dressings in the complex treatment of purulent-necrotic wounds: Guidelines No. 2000/156 . M., 2000.
16. Multimedia guide "Purulent surgical infection" / Ed. V. D. Fedorova, A. M. Svetukhina. M., 2001.

Note!

• Experience in the treatment of complicated forms of abscesses and soft tissue phlegmon indicates the need for active influence on the emerging purulent process, which involves not only radical surgical intervention, but also additional methods of treating the wound surface.
• In the postoperative period, it is necessary to use modern antiseptics for local treatment of wounds, and they should be prescribed differentially, in accordance with the phase of the wound process.
• This tactic allows you to quickly eliminate the acute purulent process, as well as reduce the time of preparation for final stage surgical treatment wounds and time spent in the hospital.
• Rational use modern antibiotics in combination with topical antiseptic agents, it allows a significant number of patients to reduce the duration of systemic antibiotic therapy.

- This is a purulent process in fatty tissue, which does not have clear boundaries and is prone to spread to surrounding tissues. The causative agent is most often Staphylococcus aureus. Phlegmon is manifested by general malaise and intoxication, a significant increase in body temperature, severe pain during movement and palpation of the affected area. Superficial phlegmon is characterized by palpation of a dense infiltrate, which, gradually softening, turns into a cavity filled with pus. The diagnosis is established on the basis of the clinical picture. Treatment of phlegmon is carried out by opening and draining it, using proteolytic enzymes and wound healing ointments.

Causes of phlegmon

The direct cause of the purulent process in the vast majority of cases are pathogenic microorganisms that penetrate into the cellular spaces directly through a wound or abrasion, or through the lymphatic or blood vessels. Most often, phlegmon develops under the influence of Staphylococcus aureus, the second most common is streptococcus.

The occurrence of phlegmon may be due to other microorganisms. So, for example, in young children, phlegmon is sometimes provoked by a hemophilic bacterium. When bitten by a dog or cat, Pasturella multocida penetrates the tissues, which can cause phlegmon with a very short incubation period(4-24 hours). And as a result of an injury received while working with poultry, pigs, marine fish or mollusks, the bacterium Erysipelothrix rhusiopathiae can cause phlegmon.

Most often, bacteria penetrate into the subcutaneous tissue through damaged skin or mucous membranes. In addition, infectious agents can enter the cellular space by the hematogenous or lymphogenous route from some source of infection (for example, with tonsillitis, furunculosis, caries). Contact spread of inflammation is also possible when a purulent focus breaks (for example, an abscess or carbuncle). In some cases, phlegmon may not be caused by pathogens, but chemicals. Thus, the development of purulent inflammation in subcutaneous tissue possible with the introduction of gasoline, kerosene, turpentine, etc. under the skin.

The likelihood of cellulitis increases with a decrease in the protective functions of the body, which may be due to exhaustion, immunodeficiency states (HIV infection), chronic diseases(diabetes mellitus, blood diseases, tuberculosis) or chronic intoxications(alcoholism, drug addiction). In all of the above conditions, there are more severe course and the rapid spread of phlegmon, which is due to the inability of the body to resist infection. The likelihood of infection, features of the course of phlegmon and sensitivity to drugs are also determined by the type and strain of the microorganism.

Pathogenesis

The nature and characteristics of the development of phlegmon are determined by the characteristics of the vital activity of the bacterium that caused the purulent process. So, streptococci and staphylococci cause purulent inflammation. And when infected with putrefactive streptococcus, Proteus vulgaris and Escherichia coli, putrefactive phlegmon occurs.

The most severe forms of phlegmon develop as a result of the vital activity of obligate anaerobes - bacteria that multiply in the absence of oxygen. These microorganisms include non-spore-forming (bacteroids, peptostreptococci, peptococci) and spore-forming anaerobes (clostridia), which are characterized by extreme aggressiveness, high speed destruction of tissues and a tendency to the rapid spread of inflammation. The chronic form of phlegmon (woody phlegmon) is caused by low-virulence strains of microorganisms such as diphtheria bacillus, staphylococcus aureus, paratyphoid bacillus, pneumococcus, etc.

Phlegmon classification

Phlegmon can be primary (resulting from the direct introduction of microorganisms) or secondary (developed during the transition of inflammation from surrounding tissues), acute or chronic, superficial or deep, progressive or delimited. Depending on the nature of tissue destruction in purulent surgery, serous, purulent, necrotic and putrefactive forms of phlegmon are distinguished. Taking into account localization, phlegmons are subdivided into subcutaneous, intermuscular, subfascial, retroperitoneal, interorgan, phlegmons of mediastinal tissue, phlegmons of the neck, hand, foot.

If purulent inflammation develops in the cellular spaces around an organ, its name is formed from the Latin name of the inflammation of this organ and the prefix "para", meaning "about" or "around". Examples: inflammation of the tissue around the kidney - paranephritis, inflammation of the tissue around the rectum - paraproctitis, inflammation of the tissue in the pelvic area (near the uterus) - parametritis, etc. With a rapid course of phlegmon, it can go beyond one anatomical region and spread to neighboring , capturing at the same time, for example, the buttocks, thigh and perineum or hand and forearm.

Phlegmon symptoms

For an acute process, it is typical fast start with an increase in temperature to 39-40 ° C and above, symptoms of general intoxication, thirst, severe weakness, chills and headache. With superficial phlegmon, swelling and redness appear in the affected area. The affected limb increases in volume, an increase in regional lymph nodes is determined.

In the process of palpation of the phlegmon, a sharply painful, motionless, hot to the touch formation without clear boundaries is revealed. The skin over it shines. The movements are painful, the pain also increases with a change in body position, so patients try to move as little as possible. Subsequently, in the area of ​​​​inflammation, a softening area appears - a cavity filled with pus. Pus can either break out with the formation of a fistula, or spread to neighboring tissues, causing inflammation and destruction.

Deep phlegmon is characterized by an earlier appearance and a more pronounced severity of general symptoms - hyperthermia, weakness, thirst, chills. There is a rapid deterioration in the condition, shortness of breath is possible, a decrease in blood pressure, frequent weak pulse, headache, decreased urination, cyanosis of the extremities and yellowness of the skin.

Regardless of the location (deep or superficial), acute phlegmon progresses rapidly, capturing all new areas of fatty tissue, as well as adjacent anatomical formations, and is accompanied by severe intoxication. There are five forms of acute phlegmon.

• Serous phlegmon. develops at an early stage. prevails serous inflammation: exudate accumulates in the area of ​​the affected area, adipose tissue cells are infiltrated by leukocytes. Cellulose takes on a gelatinous appearance and is saturated with a watery cloudy liquid. The border between diseased and healthy tissues is practically not expressed. Subsequently serous form may turn into purulent or putrefactive.
• Purulent phlegmon. There is histolysis (melting of tissues with the formation of pus), resulting in a cloudy, whitish, yellow or green exudate. Due to the melting of tissues with this form of phlegmon, the formation of ulcers, fistulas and cavities is often observed. With an unfavorable course of purulent phlegmon, inflammation spreads to neighboring tissues (muscles, bones, tendons), which are involved in the purulent process and are also destroyed. Pus spreads through "natural cases" - subfascial spaces and tendon sheaths. Muscles acquire a dirty gray color, are saturated with pus and do not bleed.
• putrid phlegmon. It is characterized by the destruction of tissues with the formation of gases with an unpleasant odor. Tissues with such phlegmon acquire a dirty brown or dark green color, become slippery, loose and collapse, turning into a semi-liquid smearing mass. The putrefactive decay of tissues causes severe intoxication.
• Necrotic phlegmon. Characterized by the formation of foci of necrosis, which subsequently either melt or are torn away, leaving behind a wound surface. With a favorable course of phlegmon, the area of ​​\u200b\u200binflammation is limited from the surrounding healthy tissues by a leukocyte shaft, and later by a granulation barrier. The inflammation is localized, abscesses are formed at the site of the phlegmon, which are either opened on their own or drained surgically.
• Anaerobic phlegmon. There is a widespread serous inflammatory process with the appearance of extensive areas of necrosis and the release of gas bubbles from the tissues. The fabrics are dark gray, with a fetid odor. On palpation, crepitus (soft crunch) is determined due to the presence of gas. The tissues around the focus of inflammation acquire a "boiled" appearance, there is no redness.

Chronic phlegmon can develop with low virulence of microorganisms and high resistance of the patient's body. Accompanied by the appearance of a very dense, woody infiltrate. Skin bluish over the area of ​​inflammation.

Complications

Dissemination of the infection through the lymphatic and blood vessels can cause the development of thrombophlebitis, lymphangitis and lymphadenitis. Some patients present with erysipelas or sepsis. There may be secondary purulent streaks. Facial phlegmon may be complicated by purulent meningitis. When the process spreads to nearby soft tissue and bone structures purulent arthritis, osteomyelitis, tendovaginitis may develop, with damage to the pleura - purulent pleurisy, etc. One of the most dangerous complications phlegmon is purulent arteritis - inflammation of the arterial wall with its subsequent melting and massive arterial bleeding.

Treatment of phlegmon

This disease is life-threatening and requires emergency hospitalization. In the process of treatment, a strict rule applies: in the presence of pus, it must be evacuated, so the main therapeutic measure is surgical intervention - opening and draining the purulent focus. An exception to general rule is First stage phlegmon (before the formation of an infiltrate). In this case, the operation is not performed. Patients are prescribed thermal procedures (sollux, heating pads, warming compresses), UHF therapy or compresses with yellow mercury ointment (Dubrovin bandage). The simultaneous use of UHF and mercury ointment is contraindicated.

Availability high temperature and formed infiltrate is an indication for surgical treatment phlegmon even in the absence of obvious fluctuations in the lesion. Opening and draining the area of ​​inflammation can reduce tissue tension, improve tissue metabolism and create conditions for the evacuation of the inflammatory fluid. Surgical intervention performed under general anesthesia. The opening of the phlegmon is carried out with a wide incision. At the same time, in order to ensure a good outflow of pus, not only superficial, but also deep tissues are widely dissected. After leaving purulent fluid the cavity is washed and drained with rubber graduates, tubes or semi-tubes.

Bandages are applied to the wound with a hypertonic solution or water-soluble ointments containing antibiotics. Ointments on vaselinelanolin and fat-based (synthomycin emulsion, Vishnevsky ointment, neomycin, tetracycline ointment, etc.) are not indicated at the early stages, since they impede the outflow of wound contents. In order to accelerate the rejection of dead areas, special necrolytic agents are used - proteolytic enzymes (proteases, chymotrypsin, trypsin) or ointments containing enzymes.

After cleansing the wound cavity, ointment dressings are used. Troxevasin and methyluracil ointments are used to stimulate regeneration, fat-based ointments are used to protect granulation tissue from damage, and water-soluble ointments are used to prevent re-infection. In the phase of epithelialization and scarring, dogrose and sea ​​buckthorn oil. For a long time non-healing wounds and extensive defects, dermoplasty is performed.

At the same time with local treatment conservative therapy is carried out to improve defensive forces organism, fighting infection and intoxication. The patient is prescribed bed rest. The affected area, if possible, is given an elevated position. Painkillers are usually administered intramuscularly. All patients must undergo antibiotic therapy. Preparations are selected taking into account the sensitivity of the pathogen. At anaerobic phlegmons intramuscularly or subcutaneously apply antigangrenous sera.

To regulate the acid-base state of the blood and neutralize toxins, a solution of urotropin is administered intravenously, to improve vascular tone - a solution of calcium chloride. To improve the nutrition of the heart muscle, a glucose solution is used intravenously. If necessary, use drugs that normalize activity of cardio-vascular system(caffeine, etc.). Assign plentiful drink, intravenous infusion therapy, vitamin therapy, restorative agents and immunomodulatory drugs. Antibiotic therapy is continued until the elimination of acute inflammation.

Forecast and prevention

The prognosis is determined by the extent of the lesion, the nature of the purulent process, general condition the health of the patient and the time of initiation of treatment. With late treatment, the development of complications, a fatal outcome is possible. After recovery, rough scarring is often observed, external defects are possible, and the function of the affected segment is impaired. Prevention of phlegmon consists in the prevention of injuries, the treatment of wounds and abrasions, the timely treatment of foci of infection ( carious teeth, boils, pyoderma, etc.). If the first signs of inflammation occur and the slightest suspicion of phlegmon should immediately consult a doctor.

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, has a message 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 phlegmon secrete:

• 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. putrid - summoned anaerobic microorganisms, which emit certain unpleasant odors in the course of their life. Affected tissues are brown or green color, disintegrate in the form of a gelatinous mass and emit fetid odor. This creates conditions for rapid penetration 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. At sharp decline immune forces of a person, 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 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, most often this variety purulent lesion fatty tissue (cellulitis) are subject to the following parts of the body:

• 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), revealed by holding general examination abdominal cavity with frequent complaints of the patient on 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 significant pain in this area, The lymph nodes located near the focus of inflammation increased. With the further development of the disease, 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 the process of 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 caries teeth and the like.

Superficial abscesses and phlegmon of the neck most often occur over the deep cervical fascia and therefore they do not pose a particular danger, as they are easily accessible to operational autopsy. Most neck phlegmons are localized in the chin and submandibular regions. Clinical picture with this type of phlegmon, the following: 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, phlegmon progresses, and inflammation spreads to large veins facial area, 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 back side arms. 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 institution(dental surgery 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 here festering wounds, ulcers should be studied 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 on 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 delayed treatment, such common complications, such 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 that is very difficult to stop), secondary purulent streaks with distribution of the process.

Depending on the location of the phlegmon, specific complications are also distinguished, for example, purulent meningitis (inflammation 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 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.