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Carbuncle


Acute purulent-necrotic inflammation of several hair sacs and sebaceous glands with the formation of a common infiltration and extensive necrosis of the skin and subcutaneous tissue. More often it is single. The causes are the same as the boil. Contribute to the development of exhaustion, severe general diseases, metabolic diseases (diabetes, obesity) and high virulence of the pathogen (Staphylococcus aureus or Staphylo-streptococcal infection, less often streptococcus, which penetrate through hair follicles).
Symptoms and course. Carbuncle often develops on the back of the neck, interscapular and scapular areas, on the lower back, buttocks, less often on the extremities. Initially, a small inflammatory infiltrate with superficial pustules appears, which quickly increases in size. Tension of tissues leads to sharp pains on palpation, as well as arching, tearing, self-pain. The skin in the area of ​​infiltration acquires a basic shade, tense, edematous. The epidermis over the focus of necrosis breaks in several places, several holes are formed ("sieve"), from which thick greenish-gray pus is released. Necrotic tissue is visible in the holes. Separate openings merge to form a large defect in the skin, through which a lot of pus flows out and necrotic tissue is rejected.
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 in size, the general phenomena are pronounced especially sharply, but quickly subside when the release of pus and rejection of dead tissue begins. After cleansing, the wound is filled with granulations and heals.
Of the complications can be: lymphangitis, lymphadenitis, progressive thrombophlebitis, sepsis, purulent meningitis. In the carbuncle of the face, sepsis, meningitis and thrombophlebitis are more common than in its other sites.
Treatment:
The risk of complications and often severe general condition and require hospitalization of the patient in the purulent surgical department. At the beginning of the development of the carbuncle (inflammatory infiltration), antibiotic therapy is used - around the lesion with a solution of antibiotics and their intramuscular injections, while orally - sulfanilamide preparations of prolonged action. Recommended blood transfusions, etc. Locally, in the early stages of the disease - UHF. On the surface of the carbuncle impose a dry aseptic dressing or a dressing with syntomycin, streptomycin emulsion.
The patient needs rest (bed rest, immobilization, with a carbuncle, the person is forbidden to talk, give liquid food). Also shown are painkillers and heart remedies, heavy drinking, and a milk-vegetable diet.
The failure of the conservative method within 1-2 days and the increase in intoxication are indications for surgery.
When carbuncles patients with diabetes mellitus, you need careful insulin therapy, which improves the process, reducing the development of infiltration and necrosis.
Of great importance is good care for the sick. With timely and proper treatment, the prognosis is favorable. In exhausted, weakened patients suffering from severe diabetes, as well as in the carbuncle of the face, the possibility of a bad outcome is not excluded.