CARBUNKUL - acute purulent-necrotic inflammation of several hair follicles and sebaceous glands with extensive necrosis of the skin and subcutaneous tissue. Carbuncle can form as a result of the spread of the inflammatory process from one hair follicle to another with the simultaneous damage of several follicles, as well as the merger of individual boils. Occurrence of carbuncles contribute to metabolic disorders (diabetes, obesity), reduced nonspecific reactivity of the body, non-compliance with sanitary and hygienic rules in everyday life and at work. Often, the carbuncles cause staphylococci, less often - streptococci, E. coli, proteus, enterococci, non-clostridial anaerobes.
A carbuncle is usually single. Localized on the neck, in the interscapular region, on the face, lower back, buttocks, less commonly on the extremities. Initially, a small inflammatory infiltrate is formed, which quickly increases in size. The skin above it becomes edematous, bluish-purple, tense, fistulae (“sieve”) are formed in it, through which thick greenish-gray pus is secreted. The patient is worried about persistent pain in the affected area; there are chills, malaise, nausea , vomiting , loss of appetite, severe headache , insomnia, fever of up to 40 ° C, tachycardia , and sometimes delirium and unconsciousness. These manifestations are particularly pronounced in the face carbuncles and large carbuncles of other localization. The formation of necrosis usually occurs within 3-5 days. Then separate holes in the skin merge, a large defect is formed, through which pus is released and purulent-necrotic masses are rejected. From this point on intoxication decreases. After cleansing the wound, it is filled with granulation tissue, and then a scar is formed.
Typical complications of the carbuncle are lymphangitis , regional lymphadenitis , progressive thrombophlebitis , sepsis , purulent meningitis . In the carbuncle of the face, the progressive acute thrombophlebitis of the veins of the face can quickly spread through the system of the superior ocular vein to the venous sinuses of the dura mater. Purulent sinus thrombosis leads to the development of purulent basal meningitis and arachnoiditis.
Treatment . On an outpatient basis, treatment of carbuncles of small size, localized on the trunk and extremities, is acceptable in the absence of severe intoxication. At the beginning of the disease, in the presence of only inflammatory infiltration, before the formation of a purulent-necrotic focus, antibacterial therapy is indicated. Antibiotics are prescribed, as a rule, with a broad spectrum of action — ampicillin , ampioks, and others. Synthetic broad-spectrum antibacterial drugs — Biseptol and Furagin . Analgesic and cardiac remedies are shown, as well as a milk-vegetable diet. The surface of the infiltrate is treated with 70% ethanol and impose an aseptic bandage. Apply ultraviolet radiation, UHF-therapy. With the favorable effect of conservative therapy, the reverse development of infiltration occurs after 2 to 3 days and is accompanied by a decrease in pain, a decrease in body temperature, and normalization of the blood picture.
The indication for surgery is the formation of a focus of necrosis. The operation for a small carbuncle is performed under local anesthesia with a 0.5-0.25% novocaine solution. Carbuncle crosswise dissect through the entire necrosis to the viable tissue, followed by necrotomy. The operation is completed by introducing tampons with a hypertonic solution of sodium chloride or proteolytic enzymes into the wound. Before the final rejection of purulent-necrotic masses, dressings are daily replaced with proteolytic enzymes, a hypertonic solution of sodium chloride, according to indications, step-by-step necrotomy is performed, then ointment-based preparations are used (10% methyluracil ointment, vinylin, etc.). After surgery, continue antibiotic therapy, physiotherapy.
The large size of the carbuncle, the progression of the necrotic process, uncompensated diabetes mellitus , the increase in intoxication are an indication for hospitalization. Treatment of a carbuncle localized on the face must also be carried out in the hospital.