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December 26, 2016 00:02

felon Treatment

Treatment aims felon, which is full and persistent relief of inflammation while minimizing the functional and aesthetic consequences and in some cases, the risk of fatal outcome.

Indications for hospitalization

Outpatient treatment is possible only if the surface forms felon.All patients with deep forms felon and phlegmon brush need to be hospitalized.Surgical treatment (sometimes repeatedly), and post-operative period, at least until the subsiding of acute inflammation should be performed in a hospital.

Surgery felon

Preoperative preparation includes washing the affected hand with warm water and soap.Noteworthy technique intramuscular broad-spectrum antibiotic for 30-40 minutes before surgery felon, which limits the spread of infection and promotes a smoother flow of postoperative period.

treatment of various forms felon

Paronychia

One or two (depending on the process prevalence) longitudinal sections mobilize okolonogtevoy roller.After necrectomy and rehabilitation should be introduced wit

h a gauze strip of ointment on hydrophilic basis between the roller and the nail plate so that the skin crease was otvёrnuta and remaining exudate can freely evacuate.With proper treatment, felon inflammation usually docked within 2-3 days.

and subungual skin felon

shown resection only detached pus of the nail plate as erosive surface of the nail bed with the complete removal of the nail is extremely painful at dressing changes.The entire nail plate is removed only when its complete detachment.Subsequently surface devoid nail treated with potassium permanganate solution to complete epithelization.

When skin felon excised epidermis exfoliation of pus that does not require anesthesia, and make a thorough revision of erosive surface as possible the spread of necrotic process more deeply, through a narrow course, and the formation of "cuffs" subcutaneous felon type.

subcutaneous felon

Due to the structural features of the fiber phalanges confine the surgical treatment only cut the skin is not enough, since it leads to the progression of purulent process in the tissue depth with the development of bone or tendon felon.Therefore, treatment with subcutaneous felon must necessarily include necrectomy - excision of all necrotic tissue.When confidence in the adequacy of the necrectomy permissible, finishing treatment, apply a drainage wash system with primary sutures.If you are unsure it is advisable to leave the wound open, loosely by filling it with a gauze strip in the water-soluble ointment base.After cleansing the wounds and reduction of acute inflammation treatment felon is closing wounds secondary seams or overlapping the edges of tape strips.

tendon felon

Whitlow requires emergency surgery, as compression of the tendon exudate quickly leads to necrosis of tender tendon fibers.Treatment of tendon panaritiums depends on the state adjacent to the tendon sheath subcutaneous tissue.

When intact tissue (in the case of tenosynovitis after injection directly into the tendon sheath) surgery to limit cuts and opening in the distal tendon sheath (on the middle phalanx) and proximally (in the projection head corresponding metacarpal bone) departments.After the evacuation of fluid and flushing the vagina with antiseptic solutions its cavity drain perforated mikroirrigatorom the entire length, and the skin edges of the wound is sutured atraumatic thread 4 / 0-5 / 0.

Where the subcutaneous tissue is also involved in suppurative destructive process produces a longitudinal section along the side surface of the finger to the arcuate extension of the palm in the projection "blind bag" tendon sheath.Skin and subcutaneous flap otpreparovyvayut from the vagina, which tends to be partially or completely necrotic, with preservation of palmar neurovascular bundles and carry out a thorough necrectomy in the subcutaneous tissue, excised non-viable areas of the tendon sheath tendon fibers and necrotic.Fully tendon was excised only if it explicitly necrosis when it is represented by a structureless mass.After applying drainage-lavage system felon treatment is to fill the wound with gauze strips with ointment on the basis of water-soluble.Closure of the wound or other means is possible only after the relief of acute inflammation and confidence tendons viability.

Bone felon

Tactics of treatment depends on the severity of inflammation in the surrounding tissues.If the disease is quite long, there is formed fistula, which is drained by purulent exudate, inflammation in the skin and subcutaneous tissue, usually not expressed.In this situation, make a radical nekrosekvestrektomiyu removed pathological granulation in the soft tissues and the wound closed with primary sutures overlaid drainage and washing system or without it (at a small size of the cavity).It should be noted that the extensive resection of bone does not operate.

Rinse the affected bone gently scrape acute bone spoon, which, as a rule, it is enough to remove necrotic avaskulyarizovannyh.In the event of sequestration phalanx removed only freely lying sequesters retaining the main body of the bone.

the presence of bone lesions of subcutaneous tissue with severe acute inflammation of the wound after sequestrectomy advisable not to take in as well as possible further progression of purulent inflammation in the soft tissues.The wound is washed with antiseptic, gauze loosely filled with a strip of ointment on the basis of water-soluble and is left open to the relief of acute inflammation.

articular and osteo-articular felon

When surgical treatment over the articular or osteoarticular felon access is usually performed from the back surface of the finger in the respective joint projection (Z-shaped).Produce arthrotomy, the revision of the joint cavity and removal of purulent exudate.In the absence of destruction foci in the bone tissue is carried out sanitation of the joint cavity with antiseptic solutions.perforated joint cavity mikroirrigatorom drained and sutured skin wound (in the absence of acute inflammation in soft tissues).In identifying bone destruction make scraping the affected areas of acute bone spoon, drain the joint cavity.An extremely important aspect of treatment of this pathology is considered further in the joint decompression, since otherwise the possible progression of destruction.Decompression is carried out in various ways: traction modified Kirschner wires for silk loop superimposed on the nail plate;developed a device for the distraction of hand joints;imposition distraction device.As a result of reduced intra-articular pressure, there is a diastasis between the articular ends, which contributes to relief of inflammation in the joint and prevents the formation of adhesions in the joint cavity.However, the imposition of distraction device is only possible in the absence of inflammation in the soft tissues of articulated phalanxes in order to avoid the development of complications related to the spokes through the inflamed tissue.

Pandaktilit

complexity of the treatment of this disease is that it simultaneously to some extent there are signs of all these disorders.The risk of loss of the phalanx or finger as a whole is extremely high.However, with the right approach to the treatment of this pathology finger saving is possible.

incision is performed on the lateral surface of the finger with the continuation of the arcuate surface on the palm of the hand in the projection of the corresponding metacarpal head.Palmar skin and subcutaneous flap otpreparovyvayut from flexor tendon with preservation of neurovascular bundles, likewise comes with rear flap.Both the flap unfolded, providing good access to all structures of the finger.The difficulty arises only when the audit section of the back-side surface of the main phalanx on the side opposite the section.Access to this zone, if necessary, carry out a separate arcuate incision on the back of the hand in the projection of the metacarpophalangeal joint.Produce a thorough necrectomy (sequestrectomy), sanitation wounds with antiseptics.Tactics completion of surgery at pandaktilite, as well as in other types of felon, depending on the severity of inflammation in the soft tissues.Completing surgery imposition of drainage and washing systems and primary seams can only be full of confidence in the adequacy of the necrectomy that, as a rule, can only be achieved under the condition of subacute purulent inflammation in the subcutaneous tissue.Under conditions of acute inflammation of the wound with gauze strips operate with ointment on the basis of water-soluble and is left open.Later, in the dressings, monitor the condition of the tissues, performing landmark necrectomy if necessary.Decompression in the joint exercise by prescription, often through extension of the nail plate Kirschner wires.As the inflammation subsided and wound cleansing treatment felon is to close the wound secondary sutures or a type of skin plasty.