Panaritium - if you can bring an extravagant bully to a surgeon

According to the medical statistics, up to 20-30% of the diseases of the morbidity before the surgeries of the outpatient hemisphere are accumulated with panaritium. This is the name given to the hospitality of the fabrics of the hollow (aka pedoshovnoy) surfaces of the fingers and the near-nail spaces. It is not easy to take on a gnarly character, and it is possible to accelerate the expansion of infections with the development of phlegmon. In most cases, superficial panaritism of the fingers of the hand is diagnosed, if the feet and the development of large forms of ailment are not included.

Causes of the blame

Panaritium - tse bacterially obumovlene nonspecifically ignited. Most often, in the capacity of an animal, there are pyogenic staphylococci and streptococci. But the fate of the іth pathogenic microorganisms (for example, other similar fungi) and microorganisms is not included. It is also a herpetic form of becoming ill.

Shlyakh penetration of zbudnik_v is viciously exogenous. The entrance gates to the greater number of vipadkiv are not very large schools. In addition, in the anamnesis of patients with panaritsia, there may be pricks with sewing heads and thorns of roslin, pores (including when shearing nigtivs), wounds caused by abnormal seizures, in the distance, or in any way

Advancing the development of the panaritium is meant for people whose work is done, for the hobby is tied with wood, metal and surface. Skillful before such a lapse of the ribalka and the workers of the ribrozdiluvalny workshops. The drift of infection is caused by bites of food, lacerated and broken wounds, critical fractures of the fingers.

Take a felon:

wrong or unfortunate obrobat otrimanih ushkojen;
wicker for a manicure has not been cleaned for a long time;
overmirne formation of edges of nigtovy plates;
nosinnya thick, filthy vented bloated;
repeated trivial maceration of the shkiri;
the appearance of diabetic diabetes, polyhypovitaminosis and immunodeficiency diseases;
chronic breakdown of microcirculation in the fingers, accumulation of vibration, repeated hypothermia, infusion of toxic spoluk (metals, mineral oils, quicklime).

In a large number of people, the disease is overwhelmed by traumas on virobnistvі and obvious professional production of skoda. For random reasons, 10-15% is brought up.

pathogenesis

The panaritian gostry is referred to the classics as surgical infections, and the stage of its development is brought up to the stages of the serpentine infestation. Penetration and further propagation of the microbial launching agent by the reaction of adjacent tissues with damaged microcirculation, increasing and migrating to the forefront of the immune system. The children from them try to phagocytose microorganisms and foreign particles, and they are considered for the wikid of non-human mediators. Purchase of exudates and many dead microbial and immune cells for saving the activity of bacteria during the transition of catarrhal inflammation in the disease. The panaritium on the toes develops behind the same mechanism.

At the same time, the pathological process on the hollow surface expands significantly into the place, which is explained by the anatomical peculiarities of the buds and the pediatric cells of the fingers. Tse zh obumovlyu the incidence of pain syndrome in panaritic such localization. Shkira in the whole region is fixed behind the additional powerless, semi-fabric partitions, so that the child can be distributed to the outskirts of the section. For some reason, a collection of flames at the panaritia locally.

Farther away, the melting of semi-tissue strands or the transition of the infectious process to the tendon, the sinus, the brush and the slopes is superimposed on the sharp horizontal extensions of the tissue. I will not only block the transition of panaritium at the phlegmon of the brush, but with the development of a septic camp. This is so possible with low immune reactivity, low malignancy to a drug, and it is seen as a proponated drug or self-correction.

Classification

The classification of panaritium is based on the glybin and localization of the ignition process. And the axis is a kind of a stalk when it does not show the key role, the nature of the flora is included in the diagnosis and clarification.

Ailment can be a mother of key forms:

shkіrny panaritsіy;
pidshkirny;
periungual, it is also called paronychia;
subungual;
suglobovoy;
cystkovy;
tendon panarits_y;
pandactylite (reduction of all tissues of the finger).

Suglobovoy, cystkovy and tendinous panaritus to lie down to a very high form, such as pandactylitis. And all the stenchs are superficial, the stench itself is diagnosed most often.

a - shkirny; b - paronychia; in - subungual; g - pidshkirny; d - tendon; e - cystkovy; g - suglobovoy; h - kistkovo-suglobovoy; i - pandactilite

Deyakі fakhіvtsі call panaritium and gnіy-fiery painful brush with damaged valleys, tilіy surfaces, interdigital prominences and pіdaponeuroticheskaja statement. Ale korektnіshe bring them to phlegmons. Filling the tilted surfaces of the proximal and middle phalanges of the fingers may not be too faint for panaritium, behind the vinaigrette of second-time treatment for pandactylitis.

Klinichna picture of the young forms of panarits_yu

Symptoms of a panaritic form include mice and general infectious manifestations. It is the tendency to deposit as a result of glybin and localization of the ignition process, as well as as a result of the instability and activity of the immune response.

Before the outlying manifestations of ailment, to recognize signs of intoxication (weakness, lack of exposure, headache, tachycardia), hyperthermia, right up to the development of a fever. The stench can be vinicatious in the most superficial form, if the monsters are surrounded by a good shkiri. It should be noted that the nature of the activity of the animal, the nature of the toxin and the reactivity of the sick organism. It can also develop regional lymphangitis and lymphadenitis.

Before the muscular manifestations, there are changes in the disease in the course of the disease: sickness, dermatitis, swelling (swelling), locally increased temperature. With superficial forms of panaritium at the stage of the transition from burning to the next stage, it is not readily seen that the pus is bought up. And in case of transdermal incisions, it is seen to be called. The soreness and infiltration of the tissue is increased to the extent of the crumbling of the affected finger and the deterioration of the circulation.

Alle, I see panaritsia Mayut and my own specialties.

School and pedagogical form

It seems about the shkirnu form in the times of the localization of the gnarly vognisch under the epidermis. The eksudat is bought up in the presence of a rozsharov shkіru, making a flat or opucly bulb. Yogo vm_st can be serous, harsh and haemorrhagic house. Patients in a shkirnoy form are rarely turned up to a lykar. The panaritium they open is mimic, richly also evacuated with pus by a way I pierce barely, for the help of manicurn's knives.

Pidshkirna form is itself broadened. It is with such a panaritium that it is the most frequent to turn to licar, most often it is already at the worst stage of becoming ill. The igniter in the fire during the whole roztashovuyutsya in the pediatric cells and to be intertwined from the sides with semi-fabric strands. The swelling of the fired fabrics is swung and is bought up to produce until the stretching of the rest of the natural fabrics. This is the reason for the swelling pain that swells, and the character swells up during the transition from the catarrhal to the hot. At the same time, chills are not readily identified.

Pidshkirny panaritsiy is pretty mimicry. It should be explained by the shimmery zakritty of the wound canal (through which infection has penetrated) until it is bought up by pus and tendencies until the infiltration is burnt along the fibrous partitions. Occasional zapalennya is possible vis-à-vis the zones of education on the hyperemic and embryonic aphid.

The form is combined, if the panaritium is the form of a sandy year with 2 different types of display: shkirnim and pidshkirnim. Most often, it develops when the basal spheres of the shkiri are melted as a result of the progress of ignition. Such a gn_ynik is also called zaponkov_dnim.

Periungual and pedunculate form

The medium is not often localized in the periungual ridges. It is worth explaining the broadening of microtraumas of shkiri tsii galuzi with an overwhelmingly strenuous manner of manikyuri, or if I am shy to shaving off bullies. Panaritium in a newly born in a large vipadk in the periungual itself. Even the young daddy doesn’t miss the good news of the young father’s wickedly traumas, unsafe manicures, or tools, or it’s shorter than getting the cutouts of the nigt’s plates from the child.

The periungual panaritium is supervised to grow up and change the rollers, for which some uncomfortable beginnings are found to dry out serous-ginna ridina. Gnіyna empty at all possible and not formvatsya, fired up to get lost at the stage of infiltration. It’s easy to produce up to the melting of deeply lying tissues, the process expands horizontally and vertically. At the same time, it’s empty, skin teeming, which can be freed up independently.

At times, the striations of the upper periungual ridge are called panaritium paronychia. Here, the igniter in the flame rots out in a perfect proximity to the base of the nigta plate, so that you can receive it. The ignition process goes into the middle form, the plate comes out of its bed. Gniy at an hour can be privatized from її sides, or in the world of growth, just go to the edge.

The subungual panaritus can be formed first and foremost, if the nigta plate is broken, or it is penetrating injury. The most common reason for the development of such a form is a rolling pin.

gostra paronychia

1. Panaritium on aphids of the fungus nigtiv
2.pіdnіgtyove panaritsіy

herpetic panaritium

tendinous panaritium

Tendinous form of congestion is rare. It can be so much less in case of severe penetrating wounds of the fingers. Get involved in the process of being involved in a child's education. Most often, tendons (virnishe, navkolishny їkh bags-pichvi) fight with progressive superficial panaritism. Moreover, the sprinkler is reactive in nature, the penetration of the protagonist and the suppuration of the already established transudate can be seen in the fake.

The Qiu form is also called tenosynovitis. The fingers of the thighs are thickly swollen, pochvonilia, gradually napivzіgnutih. Practically, intoxication is manifested. The patient sees a post-fireball, as it makes it quick for him to try an active, or passive, fiery finger. Sparingly the position of the kintzivka is to bring the patient to a time-consuming non-fancy.

The tendon form is a nayvazhchy kind of ailment, which is more often done for everything to be done quickly with a quick cob of treatment.

Cystkova ailment

Cystkovy panaritsi most often develop into kintsevy phalanxes. Here the cyst of fluff is grown, spongy, not small for the internal canal and clearly vasulyizes from the subperiosteal bladder. Tseriyє to achieve a light penetration of infection from a burnt klitkovini. Until then, on the cyst phalanges, the cyst will grow even closer to the nail bed, then it may lie in the transformation of paronychia into cystic panarits. The early form of seizure develops in case of severe fractures of the finger, and it will lead to crushing and injury to soft tissues.

In fact, the reduction of the cyst with such panaritism is osteomyelitis. It is not easy to go through the situation, if the ruining of the brush grows out after the rosette of the pediatric or the periungual head is carried out during the period of the growth. It will explain the lack of lightning of the empty and early closure of the operative wound.

Signs of cyst panaritics є post-ejaculation of the phalanx and the appearance of cyst sequestrations (shmatochkiv of the cyst) in the wretched visions of a gnarly wound. The temperature rises, the temperature rises sharply. The phalanx is nabuva club-shaped, the axial nabutazhennya on it becomes sore.

Ale to the obvious big visions of a lot of patients, they quickly shriek and do not go to waste for a likar, vvazhayuchi for beautiful self-licking with folk tricks. It will block the situation and the wider infections, right up to the development of sepsis.

sunglobovy panaritsiy

Uncommon, ale invalidizuyuh form of becoming ill. Tse destructive gn_yny arthritis. Cutting the bunches of fingers is the most frequent cause of injuries to the children at their dorsal or bicnaya surfaces, rather than a small child.

Symptoms of ailments є a sharp swelling and soreness of the affected slope is swirled, which can lead to a significant reduction in its decay. The skir above him is hot, hot, taut right up to the point of natural folds. With an unprecedented or lack of intensive treatment, the tendon bursae, cartilage cysts lie down, the slope collapses irreversibly.

Pandactylite

Pandactylite - the form of ailment does not develop. Vona may be the result of the progress of different types of panaritsia, of the broadening of the process in all the fabrics. Ale inodі pandaktіlіt form without the obvious sign of local flames. It is especially useful when the finger is infected with viscous-ruulent fecal matter, which are subdued to the point of widening and see strained toxins.

Pandactylitis supervises the importance of intoxication, gnarly inguinal lymphadenitis and potentially threatens life with a septic camp. A finger of sharp swarms, a bluish-crimson color and one with a twisted line. Patients will have a lot of intensive pain, so they can do it when they do it and try it out.

may you expedite

It is possible to accelerate panaritics of tying with extensions of gnay infections for between fingers, for the remnants of the transferred illness. Prior to them it is introduced:

Sepsis, that is, generalization of infection with the statements of secondary multiple gnarial vognisches in the small organs, development of the internal combustion engine syndrome and multiple organ failure.
Expansion of the process on the synovial bags of the brush and naval before the development of the new tendencies. It is the most important for panaritism of the 1st and 5th fingers of the hand, and even for the first and foremost fingers of the hand, it can go up to the wrist joint and move to the front. And the axis of the synovial bags of the hollow surfaces of the II-IV fingers of the hand ends blindly on the rivni of the palatal-phalanx slopes.
Phlegmon of the hand, with a widening of infection from the fingers, is most often caused by aponeurosis.
Osteomyelitis of the metacarpal and wrist cysts.
Thrombosis of Sudin with the development of state of the art ischemic necrosis of tissue, periflebitis and thrombophlebitis of symptoms.
Gn_inny lymphadenitis of regional lymphatic vessels. With a lot of diagnostics, so the titles are lymphatic panaritium. Qia ailment is characterized by inconsistency between alarms and swelling, a sign of burning fingers with symptoms of lymphogenous enlargement of infection. Moreover, inodi lymphadenitis and extravaginal intoxication appear before the appearance of a strong panaritium.
Contracture of the fingers, which is a legacy of synovial and tendon forms of congestion.

diagnostics

Diagnostics of the panaritium is based on the inclusion of the infection and ignition of the hand (or feet), on the clarification of the nature of the infection of the fingers. The patronage of the patient includes:

Look around. Likar assessing the new changes in the urazhenaya region, the signs of intoxication, the transformation of the regional (pahvovyh) lymph universities. For the microscopic look around, a sound probe is used, which allows the zone of the greatest pain and, if necessary, to the extent of a severe wound.
Taking smears when there is evidence of a vision or an open wound. Allowing to carry out bacteriological advances in the form of a child and his sensitivity to the main antibacterial problems. True, the result of such an analysis can be taken not earlier than 5-7 days, as well as the need to clean up microorganisms in the middle of the incubators.
Radiography of the oglyadov, sighting, in 2 projections. It is carried out at adolescence on a slope and a cyst shape. Ale slid vrahovuvati, as osteomyelitis of the fingernose phalanx in a large number of cases is verified radiologically only for 2-3 incidences, so that other tiny cysts of sequestration appear in the same period.
Diaphonoscopy - enlightening the tissue of the affected finger. The middle of the spot is visible as a darkening, which allows the appearance of its approximate size and shape.
Zagalnoklinichesky analysis of blood for the purpose of the turn of the fiery fiery reaction for an additional assessment of the level of SHOE, leukocytosis and the nature of the leukocyte formula.

The planning plan also rarely includes analyzes for detecting singular and tight-fitting factors. Patients enter the blood glucose level (for diabetics) and syphilis.

Clinical picture of panaritium in differential diagnostics s (especially with ugly toes), carbuncles. And inodі lіkarevі is brought to a special pathology, so the titles of chancroid panaritsіy. A common form of primary syphilis, since the entrance gates for the treponemia are microscopic to the epidermis of the fingers. It is also possible for medical doctors, for the kind of activity, to contact with potentially contaminated biological origin and tissue. The group has pathologists, who conduct spinal punctures, neurologists and anesthesiologists-resuscitators, as well as infusions by mid-level medical personnel and actions.

Yak likuvati panaritsiy: basic principle

How panaritsiy is developed, likuvannya in home minds is carried out solely under the control and for the signs of the doctor-surgeon. It is not included in the conduct of so-called small surgical engagement in outpatient minds. And in case of increased symptoms and ineffectiveness of the therapy, docillary hospitalization until the appearance of the new surgery, the action of the panaritia's development, lie in the first place as a type of tissue firing and tissue damage. At the catarrhal-infiltrative stage, conservative methods are used. To the staff of such therapy, localization is fired, the fight against the witch, the reduction of the turn of the embryo and the other manifestations of the muscles.

The appearance of a smoky pain, a sickness of hyperthermia and persha is not sleepy - signs of the transition from burning to a normal form. Tse vimagaє is also a surgical treatment for evacuating pus, seeing necrotic tissues and the root of a sufficient way to go to the current for being exudated. The communication and the technique of the operation begin in the form of a panaritium. If possible, place drainage in the wound, so that you will get stuck in the edges of the wound and will lay down the self-evacuation of the wound. The vinyatok becomes a shkirna form, in which only a wide roztin panaritium (sub-dermal michura) is carried out.

Conducted surgical treatment is additionally supplemented with conservative approaches, treatment of surgical wounds and dressings with antiseptic and anti-fatigues. Zastosuvannya Levomekol at panaritia is the most frequent movement of the world.

Since the main symptomatology of the operation does not pass, it is necessary to re-aim more accurately for the development of large forms of obstruction and acceleration.

conservatively

Conservative treatment may include:

Stagnation of antibiotics in a wide range of children, also with antibacterial effect. In a large number of vybir pads on the needles of the penicillin or cephalosporin series, linkomycin is also vicarious. All іnshі should be taken to the preparations in the choice in case of ineffectiveness of the carried out treatment. Antibiotics for panaritism of a finger can be used not only for systemic, but for muscle therapy. To practice obkolyuvannya vognischa zapalennya, promyvannya gnіynoi wounds, aplіkatsії, ointments (for example, Oflomeld). Antibiotics are also carried out internally retrogradely (without the knowledge of the jgut).
Local triva hypothermia. It can be effective at the catarrhal stage of the school and the form of the child's panaritism.
Reception of the refinery with a sun-sickly і antiapaline mark. Є sooner before the additional world.
Compressions and aplications for the protection of the anti-firing devices. Most often Dimexidum (in general dilution), Chlorhexidine, chlorophyllipt in alcoholic dosage, Vishnevsky's ointment, Levomekol are recognized. And the axis іkhtіolovaya ointment in case of a panaritic treatment in the Danish hour is infatuated with an ineffective, clinically significant effect in the main in case of herpetic nature.
Zigrivayuchі and alcohol compresses on the area fired.
Physiotherapy (UHF, ultraviolet, electrophoresis).
Immobilization, which allows you to create a functional quiet part of the picture. Additional to the world.

Conservative therapy is possible at the early stages of malignant forms of panaritism.

Hirurgichesky lіkuvannya panaritsіyu

The operation during panaritism is most often directed towards evacuation of pus, the visible necrotic mass (for example, cystic sequestrations), the stem of an adequate output from the gnarium. If necessary, it is necessary to carry out radical involvement - amputation of the unguarded phalanx or the entire finger.

Prior to the main types, the following are included:

visualization of nigtya or hocha of this part in case of gn_yny pidnіgtyov panaritia or paronychia of the upper ridge;
arc-like rosette of the shkirny and pedagogical panaritium of the kintsevo phalanx;
overlapping of 2 lines of linear growth on the lateral surfaces when the main and middle phalanges are affected;
repeated punctures of a loam (with a lobular form of ailment) and severe synovial symptoms (with a tendon form), it is permissible only at the catarrhal stage of ailment;
wide bi-sided razrizi with panaritiums of synovial infections, the stench is imposed on the main and middle phalanges at once;
uninterrupted middle growth along the hollow surface of the finger with tendon necrosis;
wide arcuate rosettes of the cyst phalanx with visible sequestrations in case of cyst panaritsia with incomplete rupture of the cyst;
amputation of one or two decile phalanges with great damaged tissue or widened osteomyelitis;
rosten of the slope emptying on the lateral surfaces, which can be tied with simple sanitation or the visible slope surfaces and the stem of iatrogenic ankylosis;
amputation of the finger from the second excision in the metacarpophalangeal joint and resection of the head of the metacarpal cyst.

Skeletal finger heals during panaritism, lie down from bagatokh chinnikiv. It makes more sense to see and stifle the activity of pathogenic flora, it makes it easier to see the process of renewal.

forecast

A superficial panarits_y is a sickness, with a friendly forecast. Outside of the patient's development, without forming defects, defects and gross deformable scars can be created. New and old forms should not lead to a total non-reversible change in the sprout zone and not, so that the most recent vigilance of the finger's phalanx is updated in an hour. And the possible irregularities of the quick-release plates will not damage the surgical correction or damage the function of the finger.

For people of professionals, it is critical to change the surface sensitivity of the fingertip after the postponed panaritism and prompt engagement. Such a problem, for example, is relevant for drukarok, crackpot, decorators. The very same roztin panaritium of the kintsevo phalanx is wrapped in a wobbling path bordering an arcuate rose, which reduces the trauma of the operation.

The prognosis for gliboky forms is to lay down on the basis of the battle, the freedom of treatment and the appearance of the organism on therapy. In case of swelling tendovaginitis and arthritis, it is possible to invalidate the patient as a result of the development of cyst-saglobovy contractures, as well as a hand. Decrease in prasezdatnіst і when the phalanx is visible, or with the whole finger. It’s not a matter of forgetting, so the operation of such an ossuary is carried out according to life, it is permissible to fit in with the generalization of infection and the possibility of a lethal result.