KARBUNKUL - acute purulent-necrotic inflammation of several hair follicles and sebaceous glands with extensive necrosis of the skin and subcutaneous tissue. A carbuncle can form as a result of the spread of the inflammatory process from one hair follicle to another with simultaneous damage to several follicles, as well as the fusion of individual boils. The occurrence of carbuncles is facilitated by metabolic disorders (with diabetes mellitus, obesity), a decrease in nonspecific reactivity of the body, and non-compliance with sanitary and hygienic rules in everyday life and at work. Often carbuncles cause staphylococci, less commonly streptococci, Escherichia coli, Proteus, enterococci, non-clostridial anaerobes.
Carbuncle, as a rule, is single. It is localized on the neck, in the interscapular region, on the face, lower back, buttocks, less often on the limbs. Initially, a small inflammatory infiltrate forms, which rapidly increases in size. The skin above it becomes edematous, cyanotic-crimson, tense, fistulas ("sieve") are formed in it, through which thick greenish-gray pus is released. The patient is worried by constant bursting pain in the affected area; chills, malaise, nausea , vomiting , loss of appetite, severe headache , insomnia, fever up to 40 ° C, tachycardia , sometimes delirium and unconsciousness are noted. These manifestations are especially pronounced with carbuncles of the face and large carbuncles of a different localization. The formation of necrosis usually occurs within 3-5 days. Then the individual holes in the skin merge, a large defect is formed, through which pus is released and purulent necrotic masses are rejected. From this moment, intoxication decreases. After cleansing the wound, it is filled with granulation tissue, and then a scar is formed.
Typical complications of the carbuncle are lymphangiitis , regional lymphadenitis , progressive thrombophlebitis , sepsis , purulent meningitis . With facial carbuncle, progressive acute thrombophlebitis of the veins of the face can quickly spread through the superior ocular vein system 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 small carbuncles that are localized on the trunk and limbs, in the absence of severe intoxication, is acceptable. At the beginning of the disease, in the presence of only inflammatory infiltrate, before the formation of a purulent-necrotic focus, antibiotic therapy is indicated. Prescribe antibiotics, as a rule, with a wide spectrum of action - ampicillin , ampiox, etc., synthetic antibacterial drugs with a wide spectrum of action - biseptol , furagin . Analgesic and cardiac drugs, a dairy and vegetable diet are indicated. The surface of the infiltrate is treated with 70% ethyl alcohol and an aseptic dressing is applied. Apply ultraviolet radiation, UHF therapy. With the favorable effect of conservative therapy, the reverse development of infiltrate 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.
An indication for surgery is the formation of a focus of necrosis. An operation for a small carbuncle is performed under local anesthesia with a 0.5 - 0.25% solution of novocaine. The carbuncle is crosswise dissected through the entire thickness of necrosis to viable tissues, followed by necrectomy. The operation is completed by the introduction of tampons with a hypertonic solution of sodium chloride or proteolytic enzymes into the wound. Before the final rejection of purulent-necrotic masses, dressings with proteolytic enzymes, a hypertonic sodium chloride solution are replaced daily, stage-wise necrectomies are performed, then ointment-based preparations are used (10% methyluracil ointment, vinylin, etc.). After the operation, antibiotic therapy and physiotherapy are continued.
The large size of the carbuncle, the progression of the purulent-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 a hospital.