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Varieties of phlegmon brush
Increased blood supply and swelling are the main symptoms that allow diagnosing phlegmon of the hand. There is a violation of working capacity, pain when pressed and an increase in temperature in the affected area. There are several additional foci of phlegmon of the hand: furuncle – purulent inflammation of the hair follicle, when diagnosed by palpation, a necrotic shaft is detected; carbuncle – purulent inflammation of the hair follicles and sebaceous glands, several rods are felt on palpation; abscess – an inflammatory process that occurs inside an organ.
All types of purulent inflammatory diseases cause an increase in body temperature, a violation of the functions of inflamed organs, in the acute course of the process, a feverish state, pains in the places of infection localization and headaches as a result of general intoxication of the body can be observed. Pain is caused by pyogenic microbes that penetrate the organs through the blood, lymph, external damage to the skin.
Doctors give a favorable prognosis only in cases of timely diagnosis, surgical removal of necrotic inflammatory foci, and strict adherence to the recommended course of antibiotic therapy.
According to the localization of the lesion, the phlegmon of the hand is divided into several varieties.
Phlegmon of the hand in the area of elevation of 1 finger
This type of phlegmon is diagnosed with painful sensations that occur when pressing on the largest tubercle in the palm of the hand, the base of the thumb (thenar), located near the wrist. The skin becomes smooth, mobility decreases, swelling extends to the radial edge of the palm. Surgery and antibiotic therapy are recommended to prevent the spread of pus over the entire surface of the palm. Necrectomy is performed in the subcutaneous tissue, holes are left in the palm for drainage.
In some cases, with extensive damage and destruction of connective tissue septa by purulent masses, the wounds are left open after removal of necrosis areas, sutures are applied after complete healing. Dimly expressed forms are recommended to be treated in the same way.
Commissural phlegmon of the hand
Phlegmon of the hand, localized in the distal part of the palm, is called commissural. The penetration of pyogenic microorganisms occurs through cracks, injuries and calluses. The functioning of the fingers is impaired, there are severe pains during flexion and extension, swelling and hyperemia extend to both parts of the palm. When infected through damaged areas of the skin, the spread of the disease has a rapid course and development, additionally flowing to the tendons and the middle of the palm. Surgery is performed along the distal crease of the palm, any inaccuracy or continuation of the inflammatory process can lead to changes in the tendons and loss of flexor performance.
Phlegmon of the hand in the region of the middle palmar space
The fascial tissues that envelop muscles, tendons and ligaments are connective tissue membranes, so the course of inflammatory processes proceeds at an accelerated pace, especially if we take into account the ways in which the infection spreads through the blood and lymph. Phlegmon of the middle space of the hand can be a complication after tendinous panaritium. The location of the fascia under the subcutaneous and fatty layer in the case of phlegmon of the hand leads to a sharp swelling of the surface of the palm, skin tension, high temperature (up to 40 ° C and above), headaches and palmar pain. General intoxication of the body, swelling and the inability to bend and unbend the fingers indicate the penetration of purulent exudate into the thenar gap and through the worm-like muscles to the back of the hand. Fascial tissues are rich in nerve endings, in connection with this, the patient experiences increased pain, and in blood vessels, through which the infection spreads very quickly throughout the entire palmar surface. Self-medication is categorically contraindicated, in this case only emergency surgical intervention with antibiotic therapy and immunomodulatory drugs will help.
Cross phlegmon of the hand
The most difficult in terms of course and cure of all forms of phlegmon of the hand is cross phlegmon. It occurs as a complication after suffering and untreated tendovaginitis (inflammation of the tendons) and can spread to the ulnar and radial synovial bags. This situation can lead to a sharp decrease in immunity and the inability to use the hand due to high pain sensitivity. The location of purulent exudate is noted on the entire surface of the palm, between the first and fifth fingers.
N-shaped phlegmon brush
The pathogenesis of the disease is the same as that of all inflammatory processes that occur with the formation of purulent exudate: sharp pain, fever, headaches, intoxication and weakening of the body. The main pain sensations are concentrated in the area where the flexor tendons of the first and fifth fingers are located. The color of the palm reaches bluish-purple, extension and bending of the fingers is difficult, bending of the fingers towards the palm is noted. It is possible to spread purulent masses to the middle and back of the palm, flow into the synovial, ulnar and radial bags, the distal part of the forearm. Treatment is carried out only by surgery. With early diagnosis and timely removal of the purulent focus, only a slight decrease in the efficiency of the hand is possible, in case of late treatment and non-compliance with the doctor’s recommendations, a complete loss of motor activity of the affected hand is possible.
Subcutaneous phlegmon of the hand
The fascial connective sheath, enveloping various organs, muscles, ligaments and bones, is located both in the deep layers and subcutaneously. In the case of subcutaneous phlegmon of the hand, the diagnosis is difficult due to the diffuse form of the focus of infection. Pathways for the penetration of pathogens can be deep wounds, damage to the skin and infection through the lymph or blood from foci of inflammation already present in the body. Symptoms of the disease in this case will be pain, swelling, temperature, decreased immunity, hyperemia.