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Phlegmon


Acute purulent diffuse inflammation of the cell spaces (subcutaneous, intermuscular, retroperitoneal, etc.). Unlike abscess, the process does not have clear boundaries. The causative agents are usually staphylococci and streptococci, but can also be caused by other pyogenic microbes that penetrate into the cellulose through accidental damage to the skin, mucous membranes or hematogenous way. Phlegmon can also be caused by the introduction of various chemical substances under the skin (turpentine, kerosene, gasoline, etc.). It is an independent disease, but it can also be a complication of various purulent processes (carbuncle, abscess, sepsis, etc.). Inflammatory exudate spreads through the cellulose, passing from one fascial box to the other through the openings for the vascular first beams. Pushing the tissues, squeezing and breaking and destroying the vessels, pus leads to tissue necrosis.
By the nature of the exudate, a serous purulent, purulent-hemorrhagic and putrefactive form of phlegmon is isolated. Depending on the localization, epi - and subfascial (intermuscular) are distinguished.
A number of phlegmon localizations have special names. So, inflammation of the pericarp cellulose is called paranephritis, parietitis - paraproctitis, etc. The most common inflammation of the subcutaneous tissue, which is associated with its weak resistance to infection and frequent injuries.
Symptoms and course:
Characterized by the rapid appearance and spread of painful swelling, diffuse reddening of the skin above it, high temperature (40 ± C and above), pain, impaired function of the affected part of the body. Then the swelling turns into a dense infiltrate, which then softens and a symptom of fluctuation appears. The flow of phlegmon is usually heavy.
Often there are malignant upstream forms, when the process rapidly progresses, capturing large areas of subcutaneous, intermuscular cellulose and is accompanied by severe intoxication.
With the secondary development of phlegmon (osteomyelitis, purulent arthritis, purulent pleurisy, peritonitis, etc.), it is necessary to identify the main zobolevapie.
Phlegmon, which has arisen primarily, can lead to a number of complications (lymphadenitis, lymphangitis, erysipelas, thrombophlebitis, sepsis, etc.). The spread of the process to the surrounding environment leads to the development of purulent arthritis, tendovaginitis and other purulent diseases. Phlegmon of the face can be complicated by progressive thrombophlebitis of the veins of the face and purulent meningitis.
Treatment:
Patients phlegmon necessarily hospitalized. At the beginning of the disease, conservative treatment is acceptable: bed rest is prescribed, rest for the diseased limb is administered, large doses of antibiotics are administered intramuscularly, abundant drink, milky-vegetable diet, cardiac funds, painkillers are prescribed. Fabrics in the circle of phlegmon are chipped with a solution of antibiotics in novocaine, locally dry heat, UHF. The process can stop: form an abscess or a limited phlegmon. Treatment is completed by opening and draining.
With progressive phlegmon, postoperative surgical intervention is unacceptable. If there is no improvement after surgery and general treatment, a local or general complication should be offered (further progression of phlegmon, thrombophlebitis, erysipelas, purulent congestion, septic state).
In severe conditions, in connection with the threat to the life of the patient is rare, but it may be necessary to amputate the limb.