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Purulent inflammation of the tissues of the finger. Patients with panaritium and its complications for a long time lose their ability to work and make up 20-25% of visitors to surgical clinics.
The causative agent is most often staphylococci, much less often streptococci, mixed flora is often noted. Minor injuries (abrasions, injections, scratches, splinters, etc.), which do not cause severe pain and therefore do not attract attention, play an important role in the development of the disease. The following types of panaritium are distinguished: 1) dermal, 2) subcutaneous, 3) bone, 4) articular, 5) tendon (tendovaginitis), 6) paronychia, 7) subungual, 8) pandactylitis (damage to all tissues of the finger).
Symptoms and course:
A constant sign is very severe pain, which is associated with the structural features of the subcutaneous tissue of the finger, its innervation and increased interstitial pressure. Redness on the inner surface of the fingers during panaritium is weakly expressed, and usually is absent on the palm. The function of the finger and hand in the inflammatory process is impaired: the finger is in a bent position and attempts to straighten it are sharply painful. The adjacent healthy fingers can also be in a bent position, but movements in them are possible and less painful.
Cutaneous felon. The inflammatory process is localized in the thickness of the skin itself, develops after minor superficial damage (splinter, etc.). The epidermis is exfoliated by exudate, which is visible through the superficial layer of the skin. Around the purulent focus, skin hyperemia and lymphangitis, which continues to the wrist and forearm, are often noted. Surgical treatment.
After removing the epidermis with uncomplicated skin panaritium, it is best to apply a bandage with a synthomycin emulsion or an indifferent ointment. With cutaneous panaritium with lymphangitis, the general condition slightly suffers. In these cases, after the operation, a bandage with a hypertonic solution of sodium chloride is applied and antibiotics are prescribed intramuscularly. The limb is immobilized with a scarf.
Subcutaneous felon. Often found form. The inflammatory process is localized mainly on the nail phalanx, but extends to others.
Fiber necrosis and its purulent fusion are noted. Pain, swelling, limited mobility of the finger and often an increase in temperature. With all panaritiums, sharp pain is pulsating in nature. Determined by the palpation of the finger, local pain allows you to accurately establish the point of greatest tissue changes, which is important for opening the focus, usually with a button probe. With the correct section, the site of the focus of necrosis and purulent fusion of the tissues should be detected and processed. If the conservative treatment is unsuccessful or when the patient is in the midst of an inflammatory process, an urgent surgical intervention is indicated, which should be carried out NOT AFTER THE FIRST SLEEPLESS NIGHT of the patient.
The success of the operation is determined by the completeness of anesthesia and good exsanguination of the finger.
Bone felon. There are primary, developing after infected stab wounds with damage to the periosteum or bone, and secondary bone panaritium, which occurs as a complication of the subcutaneous. In the early stage, the symptoms are the same as with subcutaneous, but more pronounced. Characteristically, a bulbous thickening of the nail phalanx, with palpation, sharp pain is determined. When studying with a buttoned probe, there is no limited soreness, it is noted throughout the phalanx. The general condition of the patient suffers. The temperature rises to 39-40 ± C, there is a headache, often chills. On the radiograph, destructive changes in the phalanges are detected 10-14 days after the onset of the disease.
The diagnosis is specified during the operation. Initially, they carry out vigorous antibiotic treatment, which is administered topically in combination with novocaine blockade of the finger, as well as into the veins of the back surface of the hand. The finger and hand should be immobilized with a plaster cast. In the absence of the effect of conservative treatment for 2 days, surgical intervention is indicated. In the early stage of the disease, it is limited to opening the lesion in the soft tissues and thoroughly removing the ichrotized fiber. On the phalanx, no manipulations are performed. The operation is completed by drainage of the wound. Further treatment consists in changing and using antibiotics.
Joint felon is called purulent inflammation of the interphalangeal or metacarpophalangeal joint. Microorganisms can get into the joint with puncture wounds and open injuries, or the disease occurs as a result of the spread of a purulent process with subcutaneous and bone panaritium, as well as with purulent tenosynovitis. Patients have severe pain in the finger, spindle-shaped appearance, redness of the skin. The purulent process destroys the lateral ligaments of the joint and its abnormal mobility appears, and then crepitus (crunch). Initially, the process affects only the soft tissues of the joint, then the cartilage and articular surfaces of the phalanges are destroyed. If there is pus in the joint, an arthrotomy is done: the joint is opened with two parallel incisions and washed with antibiotics. A rubber strip is introduced into the subcutaneous tissue to prevent adhesion. If the destruction of the articular surfaces is determined by radiography, they are resected. With joint panaritiums of the first finger, it is very important to maintain joint mobility. For this, it is necessary after the operation to begin early movements that contribute to the formation of a new joint. With advanced severe articular felons, finger amputation may be required.