Surgery diseases >>>> How does panaritium arise?

How does panaritium arise?

Acute purulent inflammation of soft tissues is called panaritium . The most common location of the pyogenic focus in panaritium is the phalanges of the fingers, the periungual and subungual regions of the fingers, the joints of the phalanx of the fingers or the metacarpophalangeal joints, the bones of the fingers, tendon sheaths and tendons, the subcutaneous region of the hand (especially from the palm side).

Subcutaneous adipose tissue is a favorite place for the development of panaritium , but unlike other purulent - inflammatory processes, with panaritium, inflammation rapidly spreads into the depths of the subcutaneous fat tissue, and does not "spread" over its surface. This happens due to the fact that the palmar side of the hand has an anatomical structure of soft tissues, resembling cells separated by connective tissue. An infection that enters the area of one of the cells, unable to penetrate the connective tissue, begins to spread into the deeper layers of soft tissues and involves articular joints, tendons and bones in the inflammatory process.

The causes of panaritium lie in small, sometimes minor injuries (punctures, abrasions, cuts), but against the background of low immunity, diabetes mellitus, vitamin deficiency or disorders of blood microcirculation in the peripheral regions, inflammation around the injured area becomes purulent. Panaritium can be triggered by a splinter, careless work with manicure tools, cuts and deep punctures during gardening work and cutting fish or meat products and in other traumatic situations. The main causative agents of purulent inflammation in panaritium are conditionally pathogenic microorganisms (staphylococcus, streptococcus, enterococcus), sometimes - Proteus, Pseudomonas aeruginosa or Escherichia coli.

Signs of panaritium are pronounced:

The damaged area swells, involving not only the outer, but also the inner surface of the hand or finger in the area of edema;
The skin in the area of edema is hyperemic (reddish - pink in color) and takes on a shiny appearance;
Twitching, aching pains appear in the area of inflammation, a feeling of bursting of damaged tissues, when the hand is lowered down, the pain intensifies;
The temperature can rise up to 38 in Celsius ;
Movements in the area of edema become difficult and painful (this indicates that the inflammatory process affects the joint and / or tendons);
Outwardly, the hand, or a separate phalanx, or part of it looks swollen and enlarged, the appearance of the hand or finger is distorted;
A breakthrough of purulent contents to the surface in the form of a fistula is possible.

Depending on which anatomical structure of the hand or finger is affected, the external signs of panaritium differ:

With the development of panaritium subcutaneously, the inflammation will look like a bubble, located, for example, on the phalanx of the finger from the side of the palm. This form of panaritium has a lighter course.
With inflammation of the nail fold (paronychia) - the skin in the area of the roller rises and turns white, purulent contents can shine through it.
With the spread of a purulent process under the nail plate, detachment of the entire nail plate or part of it is possible.
With the deep spread of purulent inflammation to the tendons, joints and bones, tissue edema becomes extensive, motor functions are impaired and pain becomes more intense.

Diagnosis of panaritium is not difficult and is based on a visual examination of the affected limb, but the exception is situations when deep damage to the tissues of the hand is assumed. In these cases, X-rays are taken twice: at the beginning of the diagnosis and after a week or two, since the X-ray picture of the development of the process will lag behind the clinical picture for the above period of time.

Treatment of panaritium is usually surgical, due to the fact that the time for conservative treatment, as a rule, is lost, because the purulent process usually already develops by the third day.

Surgical manipulations consist of excision of the bladder in case of subcutaneous panaritium, opening of an abscess in case of paronychia, removal of a detached nail plate (if necessary). With deep tissue lesions, incisions are made on both sides of the hand (phalanges), through drainage is carried out, the pus is allowed to recede and washed and treated with antiseptics and proteolytic enzymes.

Panaritium is dangerous in that it can cause complications - the release of the inflammatory process outside the hand and lead to phlegmon , as well as deeper purulent inflammation of tissues (pandactylitis), the treatment of which is difficult and in most cases leads to amputation of the finger. Tendons and joints affected by panaritium may partially lose mobility, bone tissues affected by panaritium - this is the reason for the development of chronic osteomyelitis and complete or partial loss of mobility of the hand or finger.