Necrotic phlegmon of newborns

Necrotic phlegmon of newborns . Phlegmon of newborns is a kind of purulent-necrotic lesion of the skin and subcutaneous tissue in children of the first weeks of life, allocated to an independent nosological unit. The disease is characterized by rapidly developing necrosis of subcutaneous tissue followed by exfoliation and necrosis of the skin.

The causative agent phlegmon most often are Staphylococcus aureus or its association with a diverse gram-negative flora. The entrance gates of infection are damaged skin, umbilical wound. Features of the structure of the skin of the newborn contribute to its easy vulnerability, and good blood supply to the cellulose, the lack of connective tissue bridges play an important role in the rapid development and spreading of the process in depth and breadth. Necrosis of the subcutaneous fatty tissue occurs in connection with the rapidly spreading thrombosis of the vessels, the development of endo- and periarteritis. Promotes the spread of infection and an abundant network of lymph vessels in the subcutaneous tissue of the newborn. Necrosis can spread rapidly into the depths, affecting the fascia, muscles, cartilage of the ribs, etc.

Typical localization of necrotic phlegmon is the lumbosacral, gluteal and interblade areas, the lateral and anterior surfaces of the thorax. The disease can also be a complication of other inflammatory processes (abscess, mastitis, suppurated coccyx cyst).

Clinical picture. The disease begins sharply with an increase in temperature to 38-39 g. C. Intoxication phenomena are rapidly increasing; The child's anxiety is replaced by lethargy, he refuses to eat. The skin becomes gray, a marble pattern appears. Characterized by frequent shallow breathing, tachycardia, deaf heart sounds, increased blood leukocytosis.

Already in the first hours of the disease, the skin shows a delimited area of ​​hyperemia and denseness, which is painful upon palpation. The skin above the lesion hot to the touch, is not going to fold. After 8-12 h, the affected area increases 2-3 times, the skin over it acquires a cyanotic hue, there is swelling of the surrounding tissues. Gradually, a softening appears in the center of the infiltration site. In some cases, skin necrosis occurs, its rejection with the formation of extensive wound defects. The bottom of the wound is gray with the remains of dead fiber, the edges are dug, uneven, granulation is absent. This kind of wound makes one suspect the development of sepsis in a child. With a favorable course after the rejection of the dead skin, small wounds (3-6 cm in diameter) are formed, which are gradually performed by granulations gradually epithelizing along the edges. In the future, on the site of a wound defect, rough scars are often formed, causing deformation of the chest, lumbar lordosis and kyphosis, progressing with the growth of the child.

Differential diagnosis is carried out with erysipelas, aseptic fibrosis necrosis.

Treatment is surgical. Produce (under local or general anesthesia) multiple cuts of the skin in checkerboard pattern over the lesion and the border with healthy skin. The length of the cut is 1-1.5 cm, in depth they must penetrate to the subcutaneous fatty tissue. Then put a bandage with hypertonic sodium chloride solution or antiseptic (furacilin, dioxidin, chlorhexidinechinogluconate) for 2-3 hours. For subsequent dressings, the spread of the process is monitored, if necessary, additional incisions are made. With necrosis of the skin and the appearance of a demarcation line, a necrectomy is performed. After cleansing the wound from necrotic masses and pus use ointment dressings. Physiotherapeutic procedures (UFO, UHF, etc.) are used throughout the treatment, as well as stimulate the growth and epithelization of granulations by using a preserved placenta, fibrin film, ultrasound treatment of the wound, laser beams.

Parallel to the local intensive therapy, the complex of which should include detoxification, antibacterial and immunostimulating measures.

The prognosis with phlegmon of newborns is always serious. The earlier the diagnosis is made and the treatment measures are started, the more likely the outcome will be.