Whitlow - an acute purulent-inflammatory diseases caused by bacterial development of fingers and toes, often - staphylococcal, At least - streptococcal or mixed flora in the finger tissue, and is accompanied with pain, suppuration, edema and redness.
Reasons felon
The most important role in causing the disease play microtraumas and damage okolonogtevoy region (e.g., cuts, pricks, splinters or burrs). Due to the fact that many of these lesions do not cause significant discomfort to man, they are a long time can remain undetected. Such defects are the entrance gate of infection, it is there that the multiplication of microorganisms. With insufficient hygienic care of the bacteria can penetrate deep into the tissues, causing purulent inflammation.
Whitlow - a disease often occurring. According to various sources, from 10 to 20% of all visitors surgeries clinics seeking help is on the felon. This prevalence of this disease is due to the complex anatomical structure of the fingers.
Kinds
Classify the disease on the anatomic basis. Whitlow is:
- cutaneous. Affected skin and subcutaneous tissue on the back surface of the finger, under which accumulates pus, formed bladder filled with purulent, sometimes bloody contents;
- okolonogtevoy, also called paronychia. Inflammation begins with the edge of the nail plate, then inflamed okolonogtevoy roller; this kind of felon is often a consequence of careless manicure;
- hyponychial. It is characterized by inflammation of the tissues under the nail plate, often due to puncture or contact splinter under the nail;
- subcutaneous. From the skin characterized by inflammation that appears on the palmar side of the finger, lies deeper, often causes complications in the form of the transition process in the bone and joint;
- bone. It arises from open fractures, or a complication of other species felon;
- joint, also called purulent arthritis interphalangeal joint. Developing against penetrating joint injury or as a complication of other species felon;
- osteo-articular. It is a combination of joint and bone forms more likely to occur with the progression of bone felon;
- tendon, also called tenosynovitis. This is the most severe form of felon with significant violations finger functions; in the absence of active treatment process applies to the brush, and in lesions I or V fingers can move on the forearm.
symptoms felon
Pain
- The most pronounced symptom is severe and constant pain, which is due to the innervation density can wear a painful throbbing in nature. The pain occurs in any kind of felon, but cutaneous form it weaker. When moving a finger ill point gain pain.
Swelling and redness of the finger
- Most often, swelling and redness of the skin appear on the back surface, they can be out on the palmar surface. The mechanism of the occurrence is caused by that, inflamed tissue finger squeezing the vessels feeding them.
Impaired motor function finger
- In particular, when tendon, bone or articular felon finger is flexed attempts to straighten it or adjacent fingers lead to increased pain sensation.
Deterioration of general well-being
- Because of the strong and constant pain, inflammation, and immune status of alert person can experience weakness, headache, temperature rises above 37.5 degrees, and with bone and joint forms - above 39.
Diagnostics
Diagnosis and treatment of felon engaged surgeon. Given the chronic inflammatory nature of the disease, especially the careful survey, examination of the patient and conduct a common blood test.
Diagnosis is based on clinical symptoms and inflammation in the blood (leukocytosis, increased erythrocyte sedimentation rate). Taking into account the very characteristic clinical picture and the need for emergency treatment, differential diagnosis and refinement of the form felon held directly during surgical treatment.
There is a subtlety, which must be remembered surgeon: in patients who have medical specialty (in particular, gynecologists, pathologists, forensic experts, urologists), felon can be confused with chancroid-felon, which is a form first syphilisAnd clinically indistinguishable from an ordinary felon. This disease may occur as a result of their professional activities, in others this form of syphilis is very rare. Therefore, your doctor may prescribe a blood analysis from a vein in Wasserman, if suspected syphilitic nature of the appearance of disease in a patient.
felon treatment
Surgical treatment consisting in anesthesia, opening of inflammatory focus, removal of pus, necrotic tissue excision followed suturing in a sectional view in a complex with conservative therapy with antibiotics, is the only effective treatment for any felon.
The operation takes 20 minutes (in mild forms) to 1 hours (or instances running at a lesion bone). It is believed that the best results can be expected if a prompt intervention is not later than the first sleepless (because of pain) of the patient at night.
Anesthesia is performed by the method of Oberst-Lukashevich. It is applied to the base of a finger and carrying harness injectable anesthetic (lidocaine or novocaine) along the nerve endings in the finger.
There are several basic methods of surgical treatment, different from each other in the number, shape and size of the cuts. Depending on the type of disease and panaritium surgeon selects the most appropriate method of surgical treatment. During the surgical procedure, assesses the amount of the inflammatory process, and then a decision on further treatment tactics.
After the operation is assigned to a course of sessions UHF and schedule dressings.
The next stage after the removal of the inflammatory focus - general or local antibiotics. For treatment using antibiotics such as erythromycin, ampicillin, oxacillin intramuscularly, to avoid complications dyspeptic (digestive disorders caused by taking antibiotics inside). In the case of bone or osteo-articular form or use morfotsiklin oleomorfotsiklin.
After 1-2 weeks after the operation finger fully regains its functionality.
If treatment is not effective, the inflammatory process is not quenched, and continues to spread, it may be decided to amputation of a finger.
possible complications
In the absence of treatment, the disease progresses very quickly. The most frequent complications are:
- the transition from one type to another felon, heavier;
- purulent arthritis (transition inflammation in the joint area);
- tenosynovitis (with the defeat of the ligamentous apparatus pneumonia reaches the channels in which ligament located, and can rapidly spread them on the hand and forearm, causing them hotbeds inflammation);
- lymphangitis (inflammation extends along the lymph channels, also causing the appearance of outbreaks in other neighboring areas brush);
- tissue necrosis (pus tends to melt the surrounding tissues, which can lead to poor circulation; in such cases, a reasonable solution would be amputation of the finger).
Forecast
It should be understood that complications always occurs in the absence of proper treatment. Most often it occurs several complications, greatly exacerbating the patient's condition and complicate treatment.
As for the rest, with timely treatment to the doctor a favorable prognosis.
