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Purulent inflammation of finger tissue. Patients with felon and its complications for a long time lose their ability to work and constitute 20-25% of visitors to the surgical clinics of polyclinics.
The causative agent is most often staphylococcus, much less streptococci, often there is a mixed flora. Minor injuries (abrasions, injections, scratches, splinters, etc.) that 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 felon are distinguished: 1) skin, 2) subcutaneous, 3) bone, 4) articular, 5) tendinous (tendovaginitis), 6) paronychia, 7) subungual, 8) pandactylitis (damage to all finger tissue).
Symptoms and course:
A permanent symptom 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 when felon is weak, and is usually absent on the palm. The function of the finger and hand in the inflammatory process is disturbed: the finger is in a half-bent position and attempts to straighten it are sharply painful. Neighboring healthy fingers can also be in a half-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 a slight superficial damage (splinter, etc.). The epidermis is exfoliated by exudate, which appears through the superficial layer of the skin. Around the purulent focus is often marked hyperemia of the skin and lymphangitis, continuing on the hand and forearm. Treatment is prompt.
After removal of the epidermis with an unfolded skin felon, it is best to apply a bandage with syntomycin emulsion or indifferent ointment. In case of skin felon with lymphangitis, the general condition is slightly affected. In these cases, after surgery, a bandage with a hypertonic solution of sodium chloride is applied and antibiotics are administered intramuscularly. The limb is immobilized with a scarf bandage.
Subcutaneous felon. Often found form. The inflammatory process is localized mainly on the nail phalanx, but extends to others.
There is necrosis of cellulose and its purulent fusion. Pain, swelling, limiting the mobility of the finger, and often a rise in temperature. With all felonies sharp pain is pulsating. The local pain determined by palpation of a finger allows you to accurately determine the point of the greatest changes in the tissues, which is important for opening the lesion, usually with a bell-shaped probe. With the right cut, the site of the source of necrosis and purulent fusion of tissues should be detected and processed. With the failure of conservative treatment or the treatment of the patient in the midst of the inflammatory process, an urgent surgical intervention is shown, which should be carried out LATER THAN THE FIRST UNFINISHABLE NIGHT of the patient.
The success of the operation is determined by the completeness of the anesthesia and good bleeding of the finger.
Bone felon. There are primary, developing after infected stab wounds with damage to the periosteum or bone, and secondary bone felon, arising as a subcutaneous complication. In the early stage, the symptoms are the same as for subcutaneous, but are more pronounced. A bulbous thickening of the nail phalanx is characteristic, with a sharp pain on palpation. In the study of the bellied probe, there is no limited pain, 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 clarified during surgery. Initially, vigorous antibiotic treatment is carried out, which is administered topically in combination with a novocaine blockade of the finger, as well as into the veins of the dorsum of the hand. Finger and brush should be immobilized with plaster longuet. 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 the opening of the lesion in the soft tissues and the careful removal of the mecrotized fiber. On the phalanx no manipulations are performed. The operation is completed drainage of the wound. Further treatment consists of changing and using antibiotics.
Joint felon is called purulent inflammation of the interphalangeal or metacarpophalangeal joint. Microorganisms can get into the joint with stab wounds and open injuries, or the disease occurs as a result of the spread of a purulent process with subcutaneous and bone felon, as well as with purulent tendovaginitis. Patients have severe pain in the finger, its spindly appearance, reddening 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 the articular surfaces of the phalanges are destroyed. If there is pus in the joint, arthrotomy is done: the joint is opened with two parallel cuts and washed with antibiotics. In order to prevent gluing, a rubber band is inserted into the subcutaneous tissue. If the destruction of the articular surfaces is determined radiographically, their resection is done. When articular felon of the first finger is very important to maintain the mobility of the joint. To do this, it is necessary to start early movements after the operation, contributing to the formation of a new joint. When running heavy articular felon may require finger amputation.