CARBUNCLE

KARBUNKUL - 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 fusion of individual furuncles. The emergence of carbuncles is facilitated by a metabolic disorder (in diabetes mellitus, obesity), a decrease in the nonspecific reactivity of the organism, non-observance of sanitary and hygienic rules at home and at work. Often carbuncles cause staphylococci, less often - streptococci, Escherichia coli, Proteus, enterococci, nonclostridial anaerobes.

Carbuncle, as a rule, is single. It is localized on the neck, in the interblade area, on the face, lower back, buttocks, less often on the limbs. First, a small inflammatory infiltrate is formed, which rapidly increases in size. The skin above it becomes swollen, cyanotic-purple, tense, in it fistula ("sieve") is formed, through which thick greenish-gray pus is secreted. The patient is worried about the constant bursting pain in the affected area; Chills, malaise, nausea , vomiting , loss of appetite, severe headache , insomnia, fever of up to 40 ° C, tachycardia , sometimes delirium and unconsciousness. These manifestations are especially pronounced in carbuncles of the face and large carbuncles of other localization. Formation of necrosis usually occurs within 3 to 5 days. Then, individual holes in the skin merge, a large defect is formed, through which pus is secreted and purulent necrotic masses are rejected. From this moment intoxication decreases. After cleaning the wound, it is filled with a granulation tissue, and then a scar is formed.

Typical complications of carbuncle are lymphangitis , regional lymphadenitis , progressive thrombophlebitis , sepsis , purulent meningitis . In the face carbuncle, the progressive acute thrombophlebitis of veins of the face can quickly spread through the system of the superior eye vein to the venous sinuses of the dura mater. Purulent sinus thrombosis leads to the development of purulent basal meningitis and arachnoiditis.

Treatment . In outpatient conditions, treatment of small-sized carbuncles, localized on the trunk and extremities, is allowed, in the absence of severe intoxication. At the onset of the disease, if there is only an inflammatory infiltrate, before the formation of a purulent necrotic focus, antibiotic therapy is indicated. Prescribe antibiotics, as a rule, a wide spectrum of action - ampicillin , ampiox, etc., synthetic antibacterial preparations of a wide spectrum of action - biseptol , furagin . Analgesic and cardiac agents, a milky-vegetative diet are shown. The surface of the infiltrate is treated with 70% ethyl alcohol and an aseptic bandage is applied. Apply ultraviolet irradiation, UHF-therapy. With the favorable effect of conservative therapy, the reverse development of the infiltrate occurs after 2 to 3 days and is accompanied by a reduction in pain, a decrease in body temperature, a normalization of the blood picture.

Indication for the operation is the formation of a focus of necrosis. The operation for a small carbuncle is carried out under local anesthesia with 0.5-0.25% solution of novocaine. Carbuncle crosswise through the entire thickness of necrosis to viable tissues followed by necrectomy. The operation is terminated by inserting into the wound tampons with hypertonic sodium chloride solution or proteolytic enzymes. Before the final rejection of purulent-necrotic masses, bandages are replaced daily with proteolytic enzymes, hypertonic sodium chloride solution, according to indications, stage necrectomies are performed, then preparations are used on an ointment basis (10% methyluracil ointment, vinylin, etc.). After the operation, antibacterial therapy, physiotherapy, is 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 carbuncles, localized on the face, also need to be done in the hospital.