Whitlow - Causes, Symptoms and Treatment .MF .
Whitlow - a purulent inflammation of soft tissues and bones of the finger.Depending on the localization of the purulent focus and depth of inflammation secrete skin, subcutaneous, subungual, joint, tendon, bone felon, pandaktilit and paronychia.
skin felon is an abscess, located beneath the skin's epidermis.In the case of nail felon, depending on the location and extent are three forms: paronychia and subungual felon.Paronychia - a purulent inflammation of the roller surrounding the nail.Subungual felon - a collection of pus under the nail.Subcutaneous whitlow is a purulent inflammation of the subcutaneous tissue phalanges.Favourite localization subcutaneous felon is the palmar side of the terminal phalanx.Tendon felon - the most severe and disabling form of purulent inflammation of the fingers, which is accompanied by the defeat and death of the tendon sheath tendon of the finger.Bone and articular felon occur primarily during deep injury to the bone and the joint cavity or the transition to the surro
Any felon called visible or unnoticed microtrauma: prick, scratch, a foreign body (eg, a pain, glass, glass, metal shavings and other), abrasions, wounds when manicure.
later received damage to the skin penetrates the causative agent.Felon causing bacteria, especially Staphylococcus aureus, and Streptococci and enterococci.Less purulent inflammation develops with the participation of Escherichia coli and Pseudomonas aeruginosa, Proteus.
predisposing factors for diabetes felon act, a violation of the blood supply to the hand, vitamin deficiency and immunodeficiencies.In such cases, purulent process develops faster, more severe and difficult to treat.
specificity of symptoms felon and nature of the flow of purulent process due to a kind of anatomy of the fingers.The fact that the skin of the palmar surface of the fingers tightly fixed to the underlying bone structures and dense connective tissue septa, forming a large number of closed cells from subcutaneous fat.Subcutaneous fat is a breeding ground for microorganisms.Therefore, when skin is damaged, and a cell infected with a nutrient medium, purulent process does not extend along the finger and at a depth in the direction of the tendon and bone.That is why there are early arching and shooting pains in the finger.The skin back surface of the fingers on the contrary loosely associated with the underlying structures, so it is easier on the rear finger edema, often detract from the underlying cause of the disease.
Depending on the type of felon clinical manifestations are different.
most easily flows intradermal felon.It looks like a bubble filled with pus, located mostly on the palmar surface of the final phalanx.Concerned about moderate pain and a feeling of fullness in the bladder area.
With paronychia, arising since the nail, there is an inflammation of the nail fold, which becomes swollen, red and painful.With continued inflammation of the skin roller is lifted, it becomes whitish - shines through it pus.Pain in paronychia vary from aching to constant, pulsating in abstsediirovaniya stage.Pus may be distributed under the nail plate to form a subungual felon, which is the main symptom of detachment of part or all of the nail plate with pus.
subcutaneous felon is accompanied by a thickening of the affected phalanx, the skin becomes red, shiny.Movement in full are impossible because of the pain of pulsating nature, which intensified when lowering the arms.
When tendon panaritiums observed thickening and reddening of the entire finger movement sharply painful.Finger becomes sosiskoobraznym is in half-bent position.Pain pronounced pulsed character.The swelling can spread to the back of the hand and the palmar surface.Festering process progresses quickly, spreading after swelling in the wrist, and even forearm.Typical symptoms of tendon felon shown in the photo below.
for joint and bone felon in pyogenic process involves joint and bone phalanx.Symptoms of bone and articular felon similar to those in subcutaneous felon, but more pronounced.Swelling usually spreads around the finger.Pain strong, intense and may not be accurate localization, the finger is bent, the movement is impossible because of pain and swelling.Possible spontaneous breakthrough of pus through the skin with the formation of purulent fistulae.In the case of articular felon initial swelling, redness and pain localized around the affected joint, but apply to the entire finger in the absence of treatment.The typical clinical picture is shown in the photo.
Symptoms articular felon.
survey at panaritiums.
If you find yourself in these symptoms should consult a doctor-surgeon clinic.In the case of paronychia, skin and subcutaneous felon diagnosed based on the clinical picture and additional instrumental examination is not required.It is enough to hand over a complete blood count and blood glucose to determine the severity of the inflammatory process and the diagnosis of diabetes, and if any degree of severity of the disease.In case of suspicion of bone and articular felon, as well as tendon panaritiums (to avoid bone involvement in the inflammatory process) is necessary to perform radiography brush.Please be aware that the X-ray pattern behind the clinical 1 - 2 weeks.Therefore, X-rays should be performed again after a specified period of time.
In the initial stages of the inflammatory process is possible conservative treatment in the form of antibiotic therapy, baths with hypertonic saline and physiotherapy.Often, however, this stage of inflammation, patients miss and do not seek medical help.
purulent processes in the finger usually develops on day 3 post-infection.This is evidenced by the constant throbbing pain and increased body temperature above 37 ° C.The first sleepless night due to pain, is an indication for surgical treatment.
When skin felon operation is excision of epidermal bubble on the border with healthy skin, treatment of 3% hydrogen peroxide solution and brilliant green.This manipulation can be performed at home with sharp nail scissors, after leaving them for 10 minutes in 70% ethanol for sterilization.The procedure is absolutely painless and requires no anesthesia.However, there is a danger felon existence in the form of cufflinks, when the bottom of the bladder has a fistula hole, going under the skin.In this case, on a par with skin felon exists and subcutaneous felon.Therefore excision exfoliated epidermis without surgical treatment for subcutaneous felon recovery would not be enough, that lead to the progression of purulent inflammation.
If paronychia formed abscess is opened by lifting the dermal roller at the base of the nail.If pus penetrates under the nail, his detachment part is removed.
Subcutaneous panaritiums perform 2 side slits on the border with the palmar surface of the skin through which the drainage is carried out through a gauze and rubber turundy graduate.They prevent adhesion of the surgical wound edges that is necessary for adequate drainage of pus and lavage of purulent cavity during dressings.
paronychia, skin and subcutaneous whitlow treated in outpatient settings.Upon confirmation of the diagnosis of the tendon, bone and articular felon in need of treatment in a department of purulent surgical infection.
Initially performing partial processing of the purulent focus, as in the subcutaneous felon.In the future hold individual treatment.
felon Antibiotic therapy in an outpatient setting reduces to receive such drugs as tsiprolet 500 mg 2 times a day for 7 days or amoxiclav 625 mg 3 times a day for 7 days.
for the prevention of felon in a timely manner is very important to properly process the resulting brush wound.should wash their hands with soap and water, remove foreign bodies from the wound (thorn, metal shavings, glass and so on), to squeeze out a drop of blood from the wound, treat the 3% hydrogen peroxide solution, the wound edges to grease an alcoholic solution of iodine or brilliant green when picked up microtrauma.Cover the bactericidal plaster or sterile cloth.
When performing a manicure to avoid damage to the skin before the procedure to process the cuticle and the surrounding skin with 70% alcohol.Nail clippers as well be immersed in 70% ethanol for 5-10 minutes.When the skin is damaged it should be treated with ethyl alcohol and to avoid pollution of land, with meat cutting and so on.
When running panaritiums a transition to deeply lying tissue inflammation with the development of pandaktilita.Last difficult to treat and often leads to amputation of a finger.Go purulent inflammation in the tendon and the lack of timely surgical treatment causes necrosis of the tendon with the loss of active movement in the finger brush.According to the tendon sheath purulent process is spreading rapidly in the brush with the development of cellulitis brush, for the treatment of which requires extensive surgery.
articular felon often leads to the formation of contractures and stiffness in the affected joint.
Bone felon often leads to the development of chronic osteomyelitis of the thumb with recurrent, accompanied by partial or complete loss of mobility.
Therefore, when self panaritiums dangerous and can lead to tragic consequences.A positive outcome in this disease is only possible when early treatment for medical help.Take care of your health.It is better to overestimate the severity of your symptoms, rather than later, seek medical attention.
Surgeon Thews DS