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Carbuncle


Acute purulent-necrotic inflammation of several hair sacs and sebaceous glands with the formation of general infiltrate and extensive necrosis of the skin and subcutaneous tissue. More often solitary. The causes are the same as the boil. Depletion, severe general diseases, metabolic diseases (diabetes mellitus, obesity) and the high virulence of the pathogen (Staphylococcus aureus or Staphylococcus aureus infection, less commonly streptococcus, which penetrate the hair follicles) contribute to the development.
Symptoms and course. Carbuncle often develops on the back of the neck, interscapular and scapular regions, on the lower back, buttocks, and less commonly on the extremities. Initially, a small inflammatory infiltrate appears with a superficial pustule, which rapidly increases in size. Tension of the tissues leads to sharp pain during palpation, as well as bursting, tearing, independent pain. The skin in the area of ​​infiltrate acquires a basic shade, tense, swollen. The epidermis above the focus of necrosis erupts in several places, several holes ("sieve") are formed, from which thick greenish-gray pus is secreted. Necrotic tissue is visible in the holes. Separate holes merge, forming a large defect in the skin, through which much pus flows and necrotic tissue is torn away.
The temperature rises to 40 ± C, there is significant intoxication (nausea and vomiting, loss of appetite, severe headache, insomnia, occasionally delirium and unconsciousness). With carbuncles localized on the face, as well as with large ones, general phenomena are especially pronounced, but quickly decline, when pus is excreted and dead tissue is rejected. After cleansing, the wound is filled with granulations and heals.
Complications may include lymphangitis, lymphadenitis, progressive thrombophlebitis, sepsis, purulent meningitis. With facial carbuncle, sepsis, meningitis and thrombophlebitis are more common than with other localizations.
Treatment:
The danger of complications and often a difficult general condition also require hospitalization of the patient in a purulent surgical department. At the beginning of the development of the carbuncle (inflammatory infiltrate), antibiotic therapy is used - chipping the focus with a solution of antibiotics and their intramuscular injections, inside - sulfonamide drugs of prolonged action. Recommended blood transfusion, etc. Locally, in the early stages of the disease - UHF. A dry aseptic dressing or dressing with a synthomycin, streptomycin emulsion is applied to the surface of the carbuncle.
The patient needs peace (bed rest, immobilization, with carbuncle, the person is forbidden to talk, they are given liquid food). Painkillers and heart remedies, heavy drinking, a dairy and vegetable diet are also indicated.
The failure of the conservative method for 1-2 days and the increase in intoxication are indications for surgical intervention.
With carbuncles, patients suffering from diabetes need careful insulin therapy, which improves the course of the process, reducing the development of infiltrate and necrosis.
Good care is of great importance. With timely and proper treatment, the prognosis is favorable. In exhausted, weakened patients suffering from severe diabetes mellitus, as well as with facial carbuncle, the possibility of a poor outcome is not excluded.