Phlegmon in adults

With phlegmon surgeons usually meet. The disease is insidious, it can develop quickly, damaging soft tissues and even bones.

What is phlegmon

Phlegmon is a purulent lesion in the subcutaneous adipose tissue. Unlike many other purulent complications, with phlegmon there are no clear boundaries of the affected tissue and unaffected by inflammation, so pus can quickly spread between cells, spreading to the muscle area, damaging bone tissue, tendons and internal organs.

Phlegmon can develop as an independent pathology, or occurs as a complication of other diseases – carbuncles, sepsis or abscesses. It is possible on the face, neck, inside the body cavities, on the limbs, in the area of ​​fractures, wound surfaces.

Causes of phlegmon in adults

The main cause of phlegmon is the penetration of pathogenic bacteria into the fiber, which cause purulent damage to the affected tissues. They can get into the tissue from skin wounds, abrasions, cuts, or are brought with blood or lymph from other foci in the body. The two most common germs that cause cellulitis are Staphylococcus aureus and Streptococcus aureus.

Less commonly, it can be caused by other bacteria – Haemophilus influenzae, in animal bites – Pasturella multocida, an aggressive microbe that can destroy tissues in a day. If the wound was received while working with small livestock, poultry, after butchering sea fish, the occurrence of phlegmon can be provoked by pathogens Erysipelothrix rhusiopathiae.

Phlegmon can develop if a purulent focus appears, for example, as a complication of a carbuncle or abscess. In rare cases, provocateurs of phlegmonous lesions can be aggressive substances – turpentine, gasoline, which have fallen under the skin.

Factors that reduce the immune defense of the body predispose to the development of phlegmon:

• severe exhaustion;
• immunodeficiencies, including HIV;
• chronic pathologies – blood diseases, tuberculosis, diabetes;
• alcoholism.

Often, pathology occurs in debilitated patients who are in hospitals for a long time.

Signs of phlegmon in adults

Among the key signs of phlegmon are:

• a sharp increase in temperature to extremely high numbers (39 – 40 ° C);
• general intoxication with weakness, pallor, malaise, nausea, sweating;
• chills, headache;
• redness and a sharp swelling of the tissues at the site of the lesion (if it is a subcutaneous process);
• an increase in limbs in volume, a sharp reaction of the lymph nodes;
• a hot, motionless and very painful formation in the tissues is palpable, but without a clear boundary;
• the skin over the lesion is stretched and shiny, movements are very painful with minimal changes in the body;
• a site of softened tissues (purulent cavity) is gradually formed.

If these are deep phlegmons, general symptoms are more typical for them – temperature, severe weakness, chills. Shortness of breath, lowering of pressure, decrease in urine volume, blue extremities, jaundice sharply increase. Without assistance, internal organs can be affected, which gradually fail.

Classification of phlegmon in adults

Phlegmons are divided by origin into:

• primary (they occur immediately after the penetration of bacteria under the skin);
• secondary (if suppuration passes from the surrounding affected tissues, it is brought by blood and lymph).

Also, phlegmon can be acute or chronic, and in terms of distribution – superficial or deep. In addition, doctors distinguish:

• delimited phlegmon (distributed in a certain zone, without going beyond its borders);
• progressive processes (spreads very widely).

Based on the nature of the damage in the area of ​​phlegmon development, serous processes, purulent, putrefactive forms and necrotic are distinguished.

According to the localization of inflammation and suppuration, they are divided into:

• subcutaneous phlegmon (fiber affected);
• intermuscular (damaged spaces between muscle fibers and fiber);
• subfascial (affected areas of muscle fascia);
• retroperitoneal (pus penetrates into the retroperitoneal pockets);
• interorgan (cavities between internal organs are affected);
• tissue damage in the mediastinum;
• cervical;
• stop and brushes.

To designate phlegmon around certain organs, the prefix “para” is used – paraproctitis, parametritis, paranephritis. This means that the fiber of these organs is involved.

Complications of phlegmon in adults

Phlegmon is a severe pathology that is dangerous for the development of complications. The spread of pus through the lymphatic and blood vessels threatens the formation of phlebitis, lymphadenitis. Possible sepsis or erysipelas of tissues. Purulent meningitis, damage to the joints, bones, pleurisy can also develop.

If the abscesses reach large arteries, their walls may melt with massive internal bleeding.

Treatment of phlegmon in adults

It is necessary to identify phlegmon as early as possible in order to begin active treatment and removal of affected tissues. Without it, serious complications are possible, up to the death of the patient.

Diagnostics

In addition to the symptoms and signs that are typical of cellulitis, doctors must run a series of tests and tests to confirm the diagnosis. It:

• general and biochemical blood tests, in which there will be signs of a purulent process;
• urine tests to assess kidney function in conditions of intoxication;
• x-ray of the affected area to assess the boundaries of the lesion;
• Ultrasound of inflamed tissues to determine the depth of damage.

If necessary, the doctor may prescribe additional tests and studies.

Modern treatments

“At all times, an effective method of treating purulent processes is their opening,” says surgeon Sergey Tarabarin. – “Ubi pus, ibi incisio” – this is exactly how one of the surgical postulates sounds in Latin (where there is pus, there is an incision). But surgery is developing rapidly, and modern medicine uses new technologies and approaches in the treatment of purulent processes.

The most effective of them is the “closed” method of treatment – evacuation followed by vacuum drainage (with active aspiration by the type of drainage according to Redon). This method allows you to operate abscesses and phlegmon without incision.

Thus, doctors save the patient from painful dressings and minimize the spread of purulent infections in the medical facility.

It has been proven that within 3 days, due to negative pressure and due to vacuum gluing of the suture, the wound heals quickly, without leaving scars, scars and other consequences of surgical intervention (the “vacuum suture” effect).

Prevention of phlegmon in adults at home

Surgeon Sergey Tarabarin noted that for any damage to the skin (cracks, scratches, abrasions, injections, cuts), the main and only prevention of infection is the local application of antiseptics.

If you receive a wound on the first day, you must contact the emergency room. If swelling and pain in the wound area appears on the second and subsequent days, this is a signal to visit the surgeon in the clinic. The sooner a person with an inflammatory process seeks medical help, the easier it will be for him to cope with this infection and exclude surgical intervention under anesthesia and further treatment in a hospital.

Popular questions and answers

What is the difference between an abscess and phlegmon, when you need a doctor’s help, is it possible to cure phlegmon at home, without operations and drugs, we asked the doctor surgeon Sergey Tarabarin.