Representing a vast defeat of living subcutaneous tissue without clearly delineated boundaries, phlegmon can affect various parts of the human body. The manifestations are quite typical, but the similarities with the abscess make it necessary to carry out a preliminary diagnosis in order to put the most accurate diagnosis. And since it depends on the diagnosis in most cases depends on the choice of treatment, subjective manifestations and survey data provide the most complete information for the attending physician.
Phlegmon, which occurs for several of the most common causes, can be localized in various parts of the body, but its manifestations are similar and bring serious discomfort to a person. Like any other lesion of the skin, phlegmon is more quickly cured if it is detected at the earliest possible stages. Therefore, even with the initial manifestations of subcutaneous tissue damage, you should consult a dermatologist for a survey.
Features of the disease
Being manifested as a lesion of living cellulose, located directly under the skin, phlegmon can occur both in the female half of the population and in the male. By age, this lesion can occur at almost any age. However, most often it is diagnosed in middle age, mainly from 35 to 55 years( these are the data of medical statistics).
The peculiarities of this purulent process in men and women have no fundamental differences.
- In childhood , a phlegmon can usually appear in a place that has been injured or mechanically exposed.
- In adult the same phlegmon can be formed not only in the place of mechanical damage, but also against the background of the current inflammatory process, and also after its treatment. Abscesses, purulent wounds, boils are the most frequent manifestations that accompany phlegmon, which largely influence and even provoke its formation.
The area of origin of phlegmon can be different. However, as practice shows, most often this type of purulent lesion of fatty tissue( phlegmon) is subject to the following body parts:
- spin( especially its lower part);
- is sometimes the face and neck area.
Because the main reason for the appearance of phlegmon is the penetration of pathogens into the tissue of fatty tissue, ruptures and cracks in the skin, these places require special attention for any mechanical damage.
Lachrymal phlegmon( photo)
Today, the generally accepted classification of such a purulent process is its division at the site of localization. And since, depending on the location of the phlegmon, there may be a slightly different symptomatology, it is necessary to determine the belonging of the developing pathological process to a certain type when performing the diagnosis.
In place of localization
So, depending on the site of localization, phlegmon is divided into the following varieties:
- Subcutaneous , which progresses directly into the layer of subcutaneous fat.
- Subfascial .
- The retroperitoneal ( phlegmon of the retroperitoneal space), revealed by conducting a general examination of the abdominal cavity with frequent complaints of the patient for tenderness in the abdomen.
- Intermuscular , which is usually accompanied by ongoing or progressive inflammatory processes in the muscle layer.
- Near-bypass , accompanied or caused by kidney disease - this is how the pathogenic microflora penetrates into this area.
- Near-intestinal , located near the rectum and its origin is due to the penetration of pathogens through the walls of the rectum. The most common cause of phlegmon in this case are long-running constipation and instability of the intestine.
Since the formation of phlegmon may not be directly related to mechanical damage to the skin and the infection is transferred into the subcutaneous tissue by hematogenous pathway with relapses and long-term ongoing diseases, it is sometimes not possible to determine the exact belonging to a certain group of phlegmon.
The phlegmon will be described in detail by a specialist in the video below:
Phd dissertation: Process stages
Phlegmon can also be classified according to the stage of the process the disease is at. Thus, the physicians distinguish:
- chronic and acute course of the disease,
- superficial location of phlegmon either finding it in the deep layers of fatty tissue,
- its limited distribution or extensive.
Usually the cause, according to medical data, of the onset and further progression of phlegmon is mechanical damage to the skin. And through the wounds and cracks on the skin quickly penetrate the pathogens that provoke a purulent process in fatty tissue.
The reason for the onset of any purulent process is the activation of pathogenic bacteria in the wound surface. Their penetration can occur not only due to ruptures and traumas of the skin, but also through separation through the circulatory and lymphatic systems. Also to the reasons that may stimulate the formation of phlegmon, include:
- penetration into the tissues of Staphylococcus aureus;
- is a hemophilic infection that is most often activated in children. It can penetrate through dog bites;
- anaerobes( bacteroides, peptococci, Clastridia);
- diphtheria bacillus.
The listed microorganisms and bacteria when entering fatty tissue against the background of a general weakening of the human body are able to begin active reproduction, and cause the onset of a purulent process called phlegmon.
Symptoms of any purulent process can be called the onset of swelling of the tissues, soreness, which increases with the progression of the disease, reddening of the affected part of the tissue and the spread of purulent process to adjacent healthy tissue in the absence of the necessary therapeutic effect.
The most obvious manifestation of phlegmon is the following:
- is the soreness of the affected area, which increases depending on the stage of the current pathological process;
- redness of the affected area;
- rapid spread of phlegmon in an acute process with an increase in the number of affected tissues;
- tenderness can manifest not only when palpation of the affected area, but also when turning the trunk.
The area of tissue damage in the development of phlegmon does not have clearly defined boundaries, however, the surface of the skin here becomes more shiny and shiny. Common manifestations in the initial stages of the disease can be considered the appearance of a headache, worsening of the general condition, a decrease in the duration and quality of a night's sleep, at later stages of the pathological process, shortness of breath, yellowing of the skin can be noted.
Diagnosis and treatment of phlegmon in newborns, children and adults are described below.
Methods for diagnosing the current process of putrefactive character in the detection of phlegmon may differ, but first of all this will be the subjective feelings of the patient.
To diagnostic measures in the development of phlegmon include:
- visual inspection of the patient,
- measurement of his body temperature( with the development of phlegmon development the temperature rises),
- also carries out the ultrasound examination at the internal location of phlegmon.
Opening and treatment of the phlegmon of the orbit, lower jaw, legs, arms( limbs), shin, mouth cavity - all this we will consider below.
Today, the therapeutic effect in detecting phlegmon can be treated with therapeutic or medicamental treatment, as well as with the help of surgical intervention. The operation can be used in those cases when there is an infiltrate in the affected area: during surgical intervention, the tissues are cleansed and the infiltrate is removed.
For treatment in the initial stages of hospitalization, the patient is not required.
- If there is no infiltration in the affected area, the doctor usually prescribes local heat in the form of warmers, warming compresses.
- A set of UHF procedures can also be recommended.
- Antibacterial therapy may also be prescribed, which stops the activity of the propagation process of pathogenic microflora.
The dissection of submandibular phlegmon is shown in this video:
Drug treatment for the detection of phlegmon should be considered the use of complex therapy with broad-spectrum antibacterial drugs to stop the purulent process in the tissues. Also, drugs can be used after surgery, with the focus of drugs - early healing of the wound surface and stopping the process of inflammation.
The drugs most often used in the treatment of phlegmon include drugs of the penicillin group, as well as agents that stimulate the rejection of necrotic tissues: Iruksol, Terrylitin, Trypsin.
Surgical intervention is the most effective method of treatment in the advanced stage of phlegmon, when the affected tissues have a purulent exudate, which during surgery should be removed.
For the operation, the patient is prescribed a complete anesthesia, which allows complete purification from the phlegmon of not only the affected tissues, but also adjacent soft tissues to prevent possible relapse after surgery.
Abscesses and phlegmons of the maxillofacial area
Prevention of the disease
As the preventive measures can be the use of drugs that increase immunity, because it is with imbalance in the functioning of the immune system, activation of all inflammatory processes in the body and its reduced ability to resist.
Also for any mechanical damage, it is necessary to carry out the treatment of skin wounds with disinfectant solutions with the greatest care to avoid getting an infection in them. And for any manifestations of discomfort after a mechanical trauma or a long-term inflammatory process in the body undergo a medical examination.
In the detection of phlegmon, the occurrence of side effects is likely, especially in the case of neglected stages with the formation of a significant amount of infiltrate. Complications of phlegmon include a high probability of deepening the current inflammatory process into neighboring tissues, which increases the risk of general infection of the body.
In determining the possible complications in the diagnosis of phlegmon, its location should be taken into account.
- So, with the formation of phlegmon in the neck region, neglected stages are fraught with suffocation due to the increase in the volume of affected tissues.
- With the formation of phlegmon in the head region, it is possible to penetrate the infection in the brain, which can cause its damage and inflammation.
With the rapid detection of phlegmon with any of its location, the patient's survival rate is usually 100%. However, with advanced stages, as well as inadequate treatment, survival is reduced and there may sometimes be an increased risk of death.
Comissural phlegmon is also operable, as described below: