Treatment of Panaritium

Treatment of panaritium pursues the goal, which consists in the complete and persistent reduction of inflammatory phenomena while minimizing functional and aesthetic negative consequences, and in some cases the risk of fatal outcome.

Indications for hospitalization

Out-patient treatment is possible only with superficial forms of panaricium. All patients with deep forms of panaritium and phlegmon brushes should be hospitalized. Operative treatment (sometimes repeated) and the postoperative period, at least, until the acute inflammation subsides, should be performed in a hospital.

Surgical treatment

Preoperative preparation includes washing the affected brush with warm water and soap. The technique of intramuscular introduction of a broad-spectrum antibiotic for 30-40 min prior to surgical treatment of panaritium deserves attention, which limits the spread of infection and promotes a more smooth course of the postoperative period.

Treatment of various forms of panaritium

Paronychia

One or two (depending on the prevalence of the process) longitudinal cuts mobilize okolonogtevoy roller. After necrectomy and sanation, a gauze strip with ointment on the hydrophilic base between the roller and the nail plate should be inserted so that the skin fold is turned off and the remaining exudate can be evacuated freely. With proper treatment, panaritium inflammation, as a rule, is docked within 2-3 days.

Subungual and skin felon

The resection is shown only by the part of the nail plate exfoliated by pus, since the erosive surface of the nail bed with complete removal of the nail is extremely painful in dressings. All the nail plate is removed only when it is completely detached. Subsequently, the surface, devoid of the nail, is treated with a solution of potassium permanganate until complete epithelization.

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

Subcutaneous felon

Due to the peculiarities of the structure of the cellulose, the phalanx of the fingers is limited to surgical treatment with only a cut of the skin, as this leads to a progression of the suppurative process into the depth of the tissues with the development of a bone or tendon panic. Therefore, treatment with subcutaneous panaritium should necessarily include necrectomy - excision of all necrotic tissue. With confidence in adequately performed necrectomy, it is permissible, when completing treatment, to impose a drainage-flushing system with primary sutures. In the absence of confidence, it is advisable to leave the wound open, filling it gently with a gauze strip with ointment on a water-soluble basis. After cleansing the wound and stopping acute inflammation, the treatment of a panic attack consists of closing the wound with secondary seams or combining its edges with strips of adhesive plaster.

Tendon of felon

Panaritium requires urgent surgical treatment, since compression of the tendon with exudate quickly leads to necrosis of tender tendon fibers. Treatment for tendon palsy depends on the condition of the subcutaneous tissue adjacent to the tendon sheath.

When the intact tissue (in the case of tenosynovitis after injection directly into the tendon sheath) surgery limit cuts and opening of the tendon sheath in the distal (on the middle phalanx) and proximally (in the projection head corresponding metacarpal bones) departments. After evacuation of the exudate and washing of the vagina with solutions of antiseptics, its cavity is drained with a perforated micririgator for the entire length, and the cutaneous edges of the wound are sewn with the atraumatic thread 4/0-5 / 0.

In the case when the subcutaneous tissue is also involved in a purulent-destructive process, a longitudinal incision is made along the lateral surface of the finger with an arcuate extension to the palm in the projection of the "blind sac" of the tendon sheath. The skin-subcutaneous flap is discarded from the vagina, which, as a rule, is partially or completely necrotized, with palmar vascular bundles preserved, and a careful necrectomy is performed in the subcutaneous tissue, non-viable parts of the tendon sheath and necrotic tendon fibers are excised. Completely the tendon is excised only if it is clearly necrosis, when it is represented by an unstructured mass. After the application of the drainage-washing system, the treatment of panaritization is to fill the wound with gauze strips with ointment on a water-soluble basis. Closure of the wound in one way or another is possible only after arresting acute inflammation and with confidence in the viability of the tendons.

Bone Panality

The tactics of treatment depend on the severity of inflammation in the surrounding tissues. If the disease proceeds long enough, there are formed fistulas, along which the purulent exudate is drained, inflammation in the skin and subcutaneous tissue, as a rule, is not expressed. In this situation, radical necrosextrrectemia is produced, pathological granulations are removed in soft tissues and the wound is closed with primary sutures with or without drainage-flushing system (with small cavity dimensions). It should be noted that extensive bone resection is not performed.

The injured bone tissue is gently scraped with a sharp bone spoon, which, as a rule, is enough to remove the avascularized necrotic areas. In the case of sequestration, the phalanx removes only free-lying sequestration with preservation of the main body of bone.

In the presence of subcutaneous tissue over the affected skin with a pronounced inflammation of the wound after sequestrectomy, it is more advisable not to suture, since further progression of purulent inflammation in soft tissues is possible. The wound is washed with antiseptics, loosely filled with a gauze strip with ointment on a water-soluble basis and left open until the acute inflammatory phenomena come to rest.

[1]

Articular and osteoarticular felon

When surgical treatment for articular or osteochondral articulation, access is usually performed from the back of the finger in the projection of the corresponding joint (Z-shaped). Produce an arthrotomy, revision of the joint cavity and removal of purulent exudate. In the absence of foci of destruction in bone tissue, the joint cavity is sanitized with solutions of antiseptics. The joint cavity is drained with a perforated micro irrigator, and the skin wound is sutured (in the absence of acute inflammation in soft tissues). When detecting bone destruction, scraping of affected areas with an acute bone spoon is made, the joint cavity is drained. An extremely important point in the treatment of this pathology is considered further decompression in the joint, since otherwise the progression of destruction is possible. Decompression is carried out in various ways: traction modified by Kirschner's needle for a silk loop applied to the nail plate; developed by the device for the distraction of the joints of the hand; the imposition of a distraction apparatus. As a result, intraarticular pressure decreases, diastasis arises between the articular ends, which facilitates the coping of inflammatory phenomena in the joint and prevents the formation of joints in the joint cavity. However, the application of the distraction apparatus is possible only in the absence of inflammation in the soft tissues of the articulating phalanges in order to avoid the development of complications associated with the carrying of spokes through inflamed tissues.

Pandactylitis

The complexity of the treatment of this pathology lies in the fact that in it at one time there are signs of all the diseases listed above in one way or another. At the same time, the risk of loss of the phalanx or finger as a whole is extremely high. However, with the correct approach to the treatment of this pathology, preservation of the finger is quite possible.

The incision is made along the lateral surface of the finger with an arcuate extension to the palmar surface of the hand in the projection of the head of the corresponding metacarpal bone. The palmar skin-subcutaneous flap is discarded from flexor tendons with preservation of the vascular-neural bundles, similarly with the back flap. Both flaps are unfolded, providing good access to all the structures of the finger. Complexity arises only when revising the portion of the rear-side surface of the main phalanx of the finger on the side opposite the incision. Access to this zone, if necessary, is carried out from a separate arcuate incision at the rear of the hand in the projection of the metacarpophalangeal joint. Produce a thorough necrotomy (sequestrectomy), sanitation of the wound with antiseptics. The tactics for the completion of surgical treatment for pandactylitis, as well as for other types of panaritium, depends on the severity of inflammatory phenomena in soft tissues. Complete surgical treatment by the imposition of drainage and rinsing system and primary sutures is possible only with full confidence in adequately performed necrectomy, which, as a rule, is achievable only under the condition of subacute purulent inflammation in the subcutaneous tissue. In conditions of acute inflammation, the wound is performed with gauze strips with ointment on a water-soluble basis and left open. Later on, on the dressings, they control the condition of the tissues, if necessary, perform the stage necrectomy. Decompression in the joint is carried out according to the indications, more often by stretching the nail plate with a Kirschner needle. As the inflammation subsides and the wound cleanses, the panaric treatment consists of closing the wound with secondary seams or one of the types of skin plasty.