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Phlegmon


Acute purulent diffuse inflammation of the cellular spaces (subcutaneous, intramuscular, retroperitoneal, etc.). Unlike an abscess, the process has no clear boundaries. Pathogens 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 hematogenous route. Phlegmon can also be caused by the introduction of various chemicals 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 fiber, passing from one fasciapal case to another through openings for the vascular-first bundles. Spreading tissues, squeezing and wailing and destroying blood vessels, pus leads to tissue necrosis.
By the nature of the exudate, serous purulent, purulent-hemorrhagic and putrefactive forms of phlegmon are distinguished. Epi - and subfascial (intramuscular) are distinguished depending on localization.
A number of phlegmon localizations has special names. So, inflammation of the perinephric fiber is called paranephritis, perienteric fiber is called paraproctitis, etc. Subcutaneous tissue is most often inflamed, which is associated with its weak resistance to infection and frequent injuries.
Symptoms and course:
They are characterized by the rapid onset and spread of painful swelling, diffuse redness of the skin above it, high temperature (40 ± C and above), pain, impaired function of the affected part of the body. Further, the swelling turns into a dense infiltrate, which then softens and a symptom of fluctuation appears. The course of phlegmon is usually severe.
Often malignant with the course of the form, when the process progresses rapidly, capturing large areas of subcutaneous, intramuscular fiber 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 goiter.
Phlegmon, which arose primarily, can lead to a number of complications (lymphadenitis, lymphangitis, erysipelas, thrombophlebitis, sepsis, etc.). The spread of the process to the surrounding tissue leads to the development of purulent arthritis, tenosynovitis and other purulent diseases. Facial phlegmon can be complicated by progressive thrombophlebitis of the veins of the face and purulent meningitis.
Treatment:
Patients with phlegmon must be hospitalized. At the beginning of the disease, conservative treatment is acceptable: bed rest is prescribed, rest for the diseased limb is provided, large doses of antibiotics are administered intramuscularly, heavy drinking, a milk-vegetable diet, heart remedies, painkillers are prescribed. Tissues around the phlegmon are chipped with a solution of antibiotics in novocaine, locally - dry heat, UHF. The process may stop: an abscess or limited phlegmon forms. Treatment ends with an autopsy and drainage.
With progressive phlegmon, a delay in surgery is unacceptable. If there is no improvement after surgery and general treatment, local or general complications should be suggested (further progression of phlegmon, thrombophlebitis, erysipelas, purulent numbness, septic state).
In serious condition, due to a threat to the patient’s life, it is rare, but it may be necessary to amputate the limb.