Phlegmon is a purulent inflammatory disease characterized by the development of a pathological focus in subcutaneous fat. The purulent focus has no clear boundaries, has a great tendency to spread throughout the pancreas. The main reason for the development of phlegmon is Staphylococcus aureus. As a rule, phlegmon is accompanied by the development of intoxication syndrome.
Phlegmon can be not only purulent, but also putrid in some cases. Both types of phlegmons spread very quickly throughout the subcutaneous tissue, and also pass to the underlying structures – muscles, nerves, tendons, up to the bone, complicated by osteomyelitis.
TYPES OF PHLEGMON
Primary phlegmon is direct contact with the pancreas and the development of pathological processes.
Secondary phlegmon is the transition of inflammation from other tissues.
Paranephritis – inflammation of subcutaneous fat around the kidney
Paraproctitis – inflammation of subcutaneous fat around the rectum
Parametritis – inflammation of subcutaneous fat around the uterus
, etc.
ETIOLOGY AND PATHOGENESIS
The main causative agent of phlegmon is Staphylococcus aureus, the second most common pathogen is Streptococcus. Pathogens enter subcutaneous fat either through skin defects (scratches, wounds and other injuries), or endogenously – through the circulatory and lymphatic system.
Another pathogen that is common among young children is hemophilic bacillus.
However, the most severe phlegmons in the clinical picture develop when pathogens enter the body that are able to multiply in the absence of oxygen – anaerobic bacteria.
CAUSES OF PHLEGMON DEVELOPMENT
Violation and weakening of immune functions.
Immunodeficiency (primary and acquired, including HIV infection).
Chronic somatic diseases – in particular diabetes mellitus, diseases of the blood system, tuberculosis, thyroiditis, etc.
Harmful social habits – alcoholism, drug addiction (to a greater extent), smoking.
Tonsillitis, furunculosis, caries.
SYMPTOMS OF PHLEGMON
The disease begins with the development of acute intoxication syndrome, namely with a sharp increase in temperature to critical figures – more than 39 degrees. Common symptoms of intoxication syndrome develop – weakness, fever, headache, body aches, photophobia, lack of appetite, chills, thirst.
If the phlegmon is located in the surface layers of subcutaneous fat, it is visually possible to detect edema, with poorly defined boundaries, hyperemia of the skin. If phlegmon forms on the limbs, they noticeably increase in volume compared to a healthy limb.
THE PATIENT COMPLAINS OF:
Painful sensations in the area of edema. The pain increases sharply with palpation.
Inflammation and pain of regional lymph nodes.
Restriction of movements due to pain.
Sometimes pus can break out – in this case, a fistula is formed, through which the pus communicates with the external environment.
With deep phlegmon, the clinical picture is the most vivid and increases rapidly. Symptoms of intoxication are very pronounced, the patient’s condition worsens very quickly, symptoms of peritonitis, respiratory and heart failure develop.
PHLEGMON FORMS
Depending on the complex of symptoms , experts have identified several types of phlegmon:
Serous (initial stage). Exudate accumulates in the area of the affected subcutaneous fat, the tissues are impregnated with leukocytes. The boundaries between pathologically altered and healthy tissue are not pronounced.
Purulent (peak period). The affected tissues melt, pus forms. With further development, secondary elements of phlegmon are formed – ulcers, fistulas, cavities. If no help is provided at this stage, the inflammation passes to the underlying tissues and organs – muscles, ligaments, internal organs, bones and nerves.
Putrefactive form (advanced inflammation). The tissue is destroyed, and gases with an unpleasant odor are formed under the influence of destructive processes. The appearance of the affected tissues becomes dirty gray, earth-colored.
TREATMENT OF PHLEGMON
All patients are subject to urgent hospitalization.
If the phlegmon is already at the stage of pus formation, urgent evacuation of it from the cavity, primary surgical treatment of the wound, the use of antiseptics and drainage of the cavity is required.
The initial phlegmon (serous) excludes surgical intervention. At this stage of development, thermal physiotherapy procedures are used.
Hypertensive compresses and bandages.
Excision of the affected tissues is used for putrefactive phlegmon. Massive areas of tissue are often excised along with muscles and other structures.
In severe cases, dermatoplasty is resorted to.
