Panaritium: symptoms and treatment at home
Panaritium is a purulent inflammation of the finger tissue of the hand, less often the foot.In most cases, I, II, and III fingers are affected.According to statistics, panaritium is more common among people aged twenty-fifty, which is primarily due to active labor activity.Thus, approximately 75% of cases are caused by occupational trauma and only 10% are domestic, 15% are due to other causes.It is worth noting that the panaritium often occurs in early childhood.And it is no wonder, after all children are very inquisitive, are active and quite often receive microtraumas of a skin.Table of contents:
Reasons for panaritium
Purulent inflammation in tissues is caused by pathogenic and opportunistic bacteria: staphylococcus, streptococcus, enterococcus, proteus or Pseudomonas aeruginosa.Microorganisms fall deep into the tissues of the finger with all sorts of cuts, puncture wounds, splinters, bites, burns, cracks. The development of purulent inflammation is also affected by the attendant factors:
- Diabetes mellitus;
- Violation of peripheral circulation;
- Immunodeficiency states.
For working people, such exacerbating factors are the effects of vibration, hypothermia, and the effects of irritating chemicals.
The skin of the palmar surface of the hand is tightly fused with the aponeurosis, their connection is provided by fibrous lintels.The bridges form closed cells filled with fat cells.Thanks to this, the infection spreads deep into the skin, not the width of the wrist.These anatomical features explain why purulent processes predominantly localize on the palmar surface.
Depending on the location of the purulent process, as well as its distribution, the following types of panaricides are distinguished:
- Okolonogevoy( paronychia);
The first four forms refer to the surface panic , the next four form to the deep .With superficial forms of the disease, the local symptoms prevail in the clinical picture, and the general symptoms are poorly expressed.And the deep forms of panaricia can strongly affect the general well-being of the patient.
Clinical manifestations depend primarily on the type of panaritium.
With this form of the disease, the purulent process is located within the skin.Often, suppuration occurs in the epidermis, while pus lifting the stratum corneum.As a result, a purulent bubble forms on the skin.The blister is surrounded by a narrow corolla of hyperemia.Yellow pus shines through the wall of the bladder.The pain with this form is weak.
With this form of the disease purulent inflammation focuses on the subcutaneous fat.The danger of subcutaneous panaritis is that the pus from the subcutaneous fat can spread to the tendon sheath, joints, bones.
In most cases, the purulent process focuses on the area of the distal phalanx of the finger on the palmar surface.After a couple of days, and sometimes several hours after receiving a microtrauma, soreness appears in this area, which then transforms into a throbbing pain, especially worse at night, which causes sleep disturbance.
Often the patient develops regional lymphadenitis, weakness, fever.
The limits of purulent inflammation are determined by the prevalence of pain, which is established when pressing on the affected area of the finger with the tip of the forceps.
In the area of soreness, the compaction and redness of the skin is determined.There may be a slight swelling in the area of the back surface of the hand.
Infection of the glaucoma is carried out because of the existing barbs, when applying microtraumas during manicure.Purulent process seeps under the nail, thereby exfoliating it from the nail bed.The peri-oral groove and the surrounding skin become swollen, swollen.There is soreness.With pressure on the affected area, pus appears on the surface of the skin.On closer examination, you can also see pus under the nail plate.
The process can be transformed into a chronic form and dragged on for weeks.
This form of the disease develops as a result of splinters under the nail or infection of the hematoma formed as a result of a bruise of the nail area.Under the nail plate, a yellowish cluster of pus is visualized, local soreness is noted.In addition, redness and puffiness in the area of the peri-oral groove are determined.The person is disturbed by the expressed throbbing pain, appreciably aggravated at lowering of an arm or a hand.
Tendon of Panaritium
Bacteria penetrate the tendon sheath of the flexor of the finger when damaged by various wounding objects or as a result of the proliferation of purulent infection from the subcutaneous tissue.The appearance of purulent exudate in the tendon sheath provokes an increase in pressure in it.Clinically, this is manifested by the appearance of severe pain.The danger is that the pressure increase and effusion compress the blood vessels, and this can lead to necrosis of the tendon.As a result, the functions of the finger are irreversibly broken.
A purulent process from the tendon sheaths of the 1st and 2nd fingers is able to spread to the deep cellular space of the forearm.And the isolated suppuration of the tendon vagina of the 1st finger can spread to the tendon sheath of the fifth finger, this phenomenon has been called the U-shaped phlegmon.
The tendon felon is leaking with a strong throbbing pain.Pain occurs when palpation along the tendon of the vagina.The affected finger is red, enlarged in size, half-bent, and when trying to unbend, painful pain arises.
This form of the disease occurs as a result of the introduction of microorganisms directly into the bone itself in the wound, but more often as a result of the spreading of purulent process to the periosteum with subcutaneous panaritium.
Bony panaritium often affects the nail phalanx.The finger is slightly bent, the slightest movements lead to increased pain.Purulent effusion leads to compression of the vessels, as well as detachment of the periosteum.As a result, bone tissue becomes necrotic.Even after drainage of a purulent foci( operative or spontaneous), the inflammatory process can become chronic due to infected dead bone tissue.With a prolonged course of the disease, the nail phalanx increases in volume and becomes thicker.
Bone feces occur with intoxication symptoms in the form of weakness, fever, lymphadenitis.
This form of the disease develops due to infection of the joint cavity when a stab wound is applied in this area or when a purulent process passes from soft tissues or an adjacent phalanx.It is noteworthy that the appearance of purulent effusion leads to rapid destruction of the elements of the joint apparatus.Therefore, a full recovery of joint function even after curing often does not occur.
In the joint area, swelling and soreness appear, which soon spread to the entire finger.Due to the destruction of the joint elements, the pathological mobility of the joint arises, as well as crepitus during movements.The general health of the person also worsens: there is a weakness, an increase in body temperature, lymphadenitis.
This is the most severe form of the disease, which occurs with the damage of the skin, subcutaneous tissue, tendons, joints and bones.It develops as a complication of cutaneous, articular, bone felon, which is possible if the patient did not turn in time to the doctor or if there are common diseases aggravating the course of the panaricium.
The affected finger is greatly enlarged and even deformed.The skin of the finger is stretched, cyanotic-purple, which indicates a marked violation of blood circulation.The finger assumes a semi-bent position.Often, on its surface, fistulas are formed, through which pus is released.
The patient feels a pronounced weakness, there is a fever, lymphadenitis.
With superficial forms, panaritium at the initial stages is possible conservative treatment with antibacterial agents and NSAIDs, physiotherapy, trays with hypertonic salt solution.Unfortunately, patients often do not consult a doctor during this period, hoping that the disease itself will pass.But after a couple of days the purulent process is gaining momentum.Surgeons are guided by the rule of the first sleepless night, which sounds like this: if the patient has not slept the night because of pain in the finger, then it's time to operate.
The operation should be performed as early as possible, since the spread of the purulent process deep into the tissue can lead to tissue necrosis.
In case of skin felon, the surgeon removes the exfoliated layer of the epidermis with scissors, and then applies a bandage with an antiseptic.
With subcutaneous panic, the surgeon applies parallel incisions, respectively, to the purulent focus, and on the nail phalanxes - sticks.After opening the abscess, the doctor excludes necrotic fiber and dissects fibrous lintels to open the cells.The cavity is drained through two incisions.Then a bandage is applied, the finger is immobilized in the required position.
For the treatment of the peri-osaginous fungus, the purulent cavity is opened, the necrotic soft tissues of the peri-osedal cushion are removed, after applying a bandage with the antiseptic.If pus accumulates under the nail, the nail plate is removed.After the operation, you need to apply bandages with ointment.The same is done with a panic attack.
Tendilar felon can sometimes be cured conservatively by puncturing the tendon sheath with aspiration of purulent contents and the introduction of an antibiotic.But in most cases you still have to resort to surgery.The surgeon applies parallel incisions on the proximal and middle phalanges, then opens the tendon sheath.The wound is washed and drained through.After the operation, the vagina is regularly rinsed with antiseptics.When the tendon withers, it is removed.
In bone gyrations, the surgeon produces longitudinal parallel incisions, removes necrotic soft tissue, and also the broken bone.At the same time, the base of the phalanx should be preserved, since it is thanks to it that regeneration of bone tissue is possible in the future.And with articular panaritium, the surgeon removes the affected joint with the prospect of creating an arthrodesis in the future.
When pandactylite is used to save a finger, the surgeon removes fragments of bones and cartilage, as well as opening pockets, swabs with their drainage.But, unfortunately, in many cases it is necessary to perform amputation of the finger.
Grigorova Valeria, medical reviewer