Panaritium - Causes, symptoms and treatment. MF.

Panaritium is a purulent inflammation of the soft tissues and bones of the finger. Depending on the location of the purulent focus and the depth of the inflammatory process, the skin, subcutaneous, subungual, articular, tendon, bone panaritium, pandactylitis and paronychia are secreted.

Cutaneous panaritium is an abscess located under the epidermis of the skin. In the case of the panic of the nail, depending on the location and distribution, three forms are distinguished: paronychia and subungual panaritium. Paronychia is a purulent inflammation of the bead surrounding the nail. The subungual panaritium is the accumulation of pus under the fingernail. Subcutaneous panaritium is a purulent inflammation of the subcutaneous tissue of the phalanges of the fingers. The preferred location of the subcutaneous panic is the palmar side of the terminal phalanx of the finger. Tendonous panaritium - the most severe and invalidating form of purulent inflammation of the fingers, which is accompanied by the defeat of the tendon sheath and the death of the tendon of the finger. Bony and articular panaritiums arise primarily in the case of a deep wound to the bone and joint cavity or when inflammation passes from surrounding tissues as a complication of subcutaneous panaritium. In the case when the purulent inflammation covers the entire thickness of the finger, they speak of pandactylitis.

Reasons for a Panaritium.

Any panaritium is caused by visible or unnoticed microtrauma: an injection, a scratch, a foreign body( for example, a splinter, glass wool, glass, metal shavings, etc.), abrasions, injuries with manicure.

Acquired pathogen penetrates the causative agent of the disease. Causes panaritium bacteria, especially Staphylococcus aureus, as well as streptococci and enterococci. Less purulent inflammation develops with the participation of intestinal and pseudomonas aeruginosa, protea.

Predisposing factors of development of panaritium are diabetes mellitus, impaired blood supply to the hand, vitamin deficiency and immunodeficiency. In such cases, the purulent process develops faster, it is more difficult and difficult to treat.

Specificity of the symptoms of the panic and the nature of the course of the purulent process are due to the peculiar anatomy of the fingers. The fact is that the skin of the palmar surface of the fingers is tightly fixed to the underlying structures and the bones are dense connective tissue partitions, forming a large number of closed cells with subcutaneous fat. Subcutaneous fat is a favorable environment for the reproduction of microorganisms. Therefore, if the skin is damaged and the cell is infected with the nutrient medium, the purulent process spreads not along the finger, but in the depth towards the tendon and bone. That is why early eruptions and shooting pains in the finger. On the contrary, the skin of the dorsal surface of the fingers is loosely connected with the underlying structures, therefore, swelling on the back of the finger is easier, often distracting from the underlying cause of the disease. Symptoms of panaritium.

Depending on the type of the panic, the clinical manifestations will be different.

The most easily occurring intradermal felon. It looks like a bubble filled with pus, located more often on the palmar surface of the terminal phalanx. Disturbing moderate pain and a feeling of raspiraniya in the field of the bladder.

With a paronychia that occurs after a manicure, there is inflammation of the nail roller, which becomes swollen, red and painful. With continued inflammation, the skin of the cushion rises, becomes whitish - pus shines through it. Pain in the paronychia varies from aching to permanent, pulsing in the abscess formation stage. Pus can spread under the nail plate with the formation of a subungual panic, the main symptom of which is the peeling of a part or the entire nail plate with pus.

Subcutaneous panaritium is accompanied by thickening of the affected phalanx of the finger, the skin turns red, glossy. Movement in full volume becomes impossible due to pains of a pulsating nature, which are amplified when the arm is lowered.

With tendon pilarism, thickening and redness of the entire finger is observed, the movements are sharply painful. The finger becomes sausage-like, is in a half-bent state. Pain is expressed, pulsating nature. Edema can spread to the rear of the hand and the palmar surface. The purulent process progresses quite rapidly, spreading after the swelling to the wrist and even the forearm. The typical symptoms of a tendon palsy are shown in the photo below.

Tendon of Panicium.

With articular and bone felon in the purulent process, the joint and the bone of the phalanx of the finger are involved. Symptoms of bone and joint panaritium are similar to those in subcutaneous panaritium, but more pronounced. Swelling, as a rule, spreads all over the finger. The pains are strong, intense and not subject to clear localization, the finger is bent, movements are impossible due to pain and swelling. A spontaneous breakthrough of pus through the skin is possible with the formation of purulent fistula. In the case of articular palsy, initially swelling, redness and pain localize around the affected joint, but in the absence of treatment spread to the entire finger. A typical clinical picture is presented in the photo. Symptoms of articular felon.

Examination at the Panaritium.

If you find these symptoms, you need to contact a doctor-surgeon at the polyclinic. In the case of paronychia, cutaneous and subcutaneous panaritium, the diagnosis is made on the basis of the clinical picture and does not require additional instrumental examination. It is enough to pass a general blood test and blood glucose to determine the severity of the inflammatory process and diagnosis of diabetes, and if there is a degree of severity of the disease. In case of suspicion of bone and joint panaritium, as well as with tendonous panaritium( to exclude the involvement of bone in the inflammatory process), it is necessary to perform a radiograph of the brush. It is necessary to know that the x-ray picture lags behind the clinical picture for 1 - 2 weeks. Therefore, the radiography should be repeated after a specified period of time.

Treatment of panaricium.

At the initial stages of the development of the inflammatory process, conservative treatment in the form of antibacterial therapy, trays with hypertonic salt solution and physiotherapy procedures is possible. However, often this stage of inflammation is missed by patients and does not seek medical help.

Purulent process in the finger usually develops on day 3 after infection. This is evidenced by persistent pulsating pains and an increase in body temperature above 37 ° C.The first sleepless night, caused by pain, is an indication for surgical treatment.

When skin felon surgery involves excising the epidermal bladder on the border with a healthy skin, processing 3% hydrogen peroxide solution and brilliant green. This manipulation can be performed at home with sharp manicure scissors, previously leaving them for 10 minutes in 70% ethyl alcohol for sterilization. The procedure is absolutely painless and does not require anesthesia. However, there is a danger of existence of a panic in the form of cufflinks, when in the bottom of the bladder there is a fistulous opening going under the skin. In this case, along with the dermal panaritium, there is a subcutaneous panaritium. Therefore, excision of exfoliated epidermis without surgical treatment of subcutaneous panaritium for recovery will be clearly insufficient, which will lead to the progression of purulent inflammation.

With paronychia, the abscess formed is opened by lifting the skin roller at the base of the nail. If pus penetrates under the nail, then its detached part is removed.

With subcutaneous panaritium, two lateral incisions are made at the border with the palmar surface of the skin, through which a through drainage is carried out in the form of a gauze turunda and a rubber graduate. They prevent the edges of the postoperative wound from sticking together, which is necessary for an adequate outflow of pus and the purging of the purulent cavity during dressings.

Paronichia, cutaneous and subcutaneous panaritium are treated in a polyclinic. When confirming the diagnosis of tendon, bone and joint panaritium, treatment is necessary in the conditions of purulent surgical infection.

At the initial stage, a partial purulent focus is performed, as with subcutaneous panaritium. Further individual treatment is carried out.

Antibiotic therapy Panaritium in outpatient conditions is reduced to taking such drugs as tsiprolet 500 mg twice a day for 7 days or amoxiclav 625 mg 3 times a day for 7 days.

Prevention of panaricium.

To prevent the development of panic attack, it is very important to handle the wound of the hand in time. When getting a microtrauma brush, wash hands with soap, remove foreign bodies from the wound( splinter, metal shavings, glass, etc.), squeeze a drop of blood from the wound, treat with a 3% solution of hydrogen peroxide, apply an alcohol solution of iodine or brilliant green to the edge of the wound. Cover with a bactericidal plaster or a sterile tissue.

When performing a manicure, skin damage should be avoided, and before processing, cuticle and adjacent skin should be treated with 70% alcohol. Manicure tweezers should also be immersed in 70% ethyl alcohol for 5-10 minutes. If the skin is damaged, it should be treated with ethyl alcohol and avoid contamination with earth, when cutting meat and so on.

Complications of panaricium.

When the panaritium is triggered, inflammation can migrate to deeper tissues with the development of pandactylitis. The latter is difficult to treat and often leads to amputation of the finger. Transition of purulent inflammation to the tendon and lack of timely surgical treatment causes necrosis of the tendon with loss of active movements in the finger of the hand. On the tendon sheath the purulent process quickly spreads to the hand with the development of phlegmon of the hand, for the treatment of which extensive surgical interventions are required.

Articular felon often leads to the formation of contractures and stiffness in the affected joint.

Bone panaritium often leads to the development of chronic osteomyelitis of the finger with a recurrent course, accompanied by partial or complete loss of mobility.

Therefore, self-medication with panarization is dangerous and can lead to tragic consequences. Positive outcome for this disease is possible only with the early application of medical care. Take care of your health. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.

Surgeon-physician Tevs DS