Cellulitis - an extensive acute purulent inflammatory process in adipose tissue.From abscess distinguishes it no clearly defined boundaries.By localization distinguish podfastsialnuyu phlegmon, subcutaneous, retroperitoneal, intermuscular, perirenal, okolopryamokishechnuyu.Pathogens cellulitis considered in greater numbers staphylococci;It may also have other pyogenic pathogens;much less common anaerobic bacteria and sticks.Because pathogens are divided into anaerobic purulent and putrid groups of microorganisms.
Pathogens cellulitis fall into fatty tissue primarily through the skin has been traumatized or localized near the foci of infection (abrasions, dental caries, lymphadenitis, etc.).Sometimes agents may be recorded by hematogenous of long persistent infection foci.
main cause of cellulitis usually microorganisms that get into kletchatochnyh area directly across the wound cavity or lymph and circulatory system.Most often isolated Staphylococcus aureus, af
development called cellulitis and other microorganisms.For example, children can be provoked abscess Hib.Dog bites in the soft tissues of the bacterium enters Pasturella multocida.It can promote phlegmon sufficiently short incubation period (6-20 hours).But such cases are, fortunately, rare.
flow characteristics cellulitis is due to features of microorganisms causing inflammatory processes.So, staphylococci and streptococci cause suppurative inflammation.But when the infection Proteus vulgaris, putrid streptococcus or Escherichia coli develops putrid form of cellulitis.
severe forms of cellulitis may develop during the life of anaerobes that may exist outside of oxygen.These include peptokokki, Bacteroides, klastridii and so on. These microorganisms are extremely aggressive with respect to the high rate of tissue damage and the tendency to the rapid spread of the inflammatory process.
Chronic abscess, which is also called, woody, develops as a result of functioning of microorganisms such as paratyphoid and diphtheria bacillus, pneumococcus, etc.
percentage of appearance cellulitis increases with a decrease in the immune status, which can be caused by anorexia, hypovitaminosis, (HIV, cancer), diabetes, blood diseases, tuberculosis, and so on. In general, under such conditions there is a more severe course of the disease andthe rapid spread of infection.
Cellulitis can be located in almost any area of the body.When cellulitis hip nature of the disease can be attributed to a primary or hit pus from the abdominal wall, hip and other areas located near.A foot abscess often develops diabetes, because if it has been a violation of the innervation of the foot, with the deterioration of tissue nutrition and blood circulation.Such cumulative pathological changes in the limbs in diabetes provide excellent conditions for the development of inflammatory processes observed in phlegmon of the foot.
It should be noted that diabetes itself influences the state of blood vessels and tissues of the foot, especially in males.
Phlegmon jaw usually occurs in advanced caries, periodontitis, pulpitis, chronic tonzilitte.Less jaw abscess comes from a lower divisions with chronic infection.
Cellulitis can be represented as primary, which arose due to the penetration of pathogens through the wound cavity in the skin, and the secondary, which develops in the transition process of inflammation of the surrounding tissue.Also it can occur either in the acute or chronic;be deep or superficial, is the limitation or progressive.
depending on the nature of the soft tissue damage is determined purulent, serous, putrid and necrotic form of cellulitis.Considering the lesion, cellulitis divided into podfastsialnye cellulitis, cellulitis subcutaneous, retroperitoneal cellulitis, cellulitis intermuscular, neck cellulitis, cellulitis mezhorgannye, cellulitis foot cellulitis brush, etc.
During purulent inflammation of the disease occurs in the cellular spaces in a particular organ.For example: paranephritis (inflammation process in kidneys), abscess (inflammation process in the rectal area), parameters (the process of inflammation in the uterus), etc.
With the rapid flow, abscess usually goes beyond a single area and goes to the neighboring, simultaneously capturing several areas.
Typically, acute abscesses characterized by rapid start of a sharp rise in temperature to 40 ° C, sometimes even above;general intoxication, accompanied by thirst, malaise, headache, chills.
When the superficial form of cellulitis in defeat edema and hyperemia of tissues.The affected area is always increases in volume due to swelling and generate pus, revealed enlarged lymph nodes in the affected area.On palpation of cellulitis is determined by extremely painful, merged with the skin to the touch with a local increase in the temperature of the formation, localized without borders.Skin on this form has a characteristic luster.Movement of the patient's painful;the pain can be amplified when turning or movement of the body, because the sick less exercise.
Later in the inflammatory process zone appears softened portion or cavity, which is filled with purulent content.Pus may break, forming a fistula, and can spread to nearby tissues.
for deeper forms of cellulitis is typical of the early bright characteristic common symptoms - fatigue, pyrexia, chills, and so forth. There may be a rapid deterioration of the accession of shortness of breath, low blood pressure, tachycardia, headache pain, the blue color of the limbs.
When cellulitis hip size upper thigh can significantly exceed the norm.In addition, palpation hip at the place where the resulting musculature, the patient feels a strong pain.The pain of such localization phlegmon observed constantly.The movement of the legs at the same difficulty.
Phlegmon person may be submitted in the form of several types.The one that affects tissues that are in the lower third of the face and the one that strikes the fabric top and middle thirds of the face.Typically, this admaxillary tissue.When there are processes involving the surface layers of cells, they are located in the area of the chin and the ears.When flow processes that encompass the deeper tissues, their localization is observed at the bottom of the mouth, under the tongue and in the pharynx.
Phlegmon jaw has some for her signs and symptoms.These include high body temperature to 40 ° C, putrid breath, general intoxication, severe swelling in the jaw, and the sharp pain on palpation, swallowing disorder, sometimes with respiratory failure.Clinic cellulitis of the jaw occurs rapidly and often inflammatory process moves to other areas of the oral cavity.
Also, when phlegmons allocate 5 following basic forms:
- serous form of cellulitis characterized the first stage of its development.The affected area is accumulated serous fluid, tissue infiltrated leukocytes.Textile fiber becomes gelatinous species, begin to soak watery opaque liquid.The edges between the sick and the healthy tissue washed.
- When purulent cellulitis form is the development of melting tissue with the appearance of pus to form a turbid exudate.There is the development of fistulas, ulcers and cavities.
- putrid form of cellulitis is characterized by tissue damage to the appearance of putrid odor vapor.Soft tissues become dark green or dirty brown color, touch become loose, slippery and converted into a semi-liquid adhesive mass.Putrefaction of tissues causing severe intoxication.
- to form necrotic cellulitis characterized by the development of necrosis, later torn away, leaving behind a wound cavity.With good area during cellulitis inflammation distinguished from healthy tissue shaft with a large formation of white blood cells, and subsequently - granulation barrier.Inflammation has a localized area.In place of education cellulitis observed the formation of abscesses, which may become evident on their own or be drained surgically.
- Anaerobic form of cellulitis occurs commonly serous inflammation with the formation of large areas of necrosis and emptying of the affected tissues vapor gas.Fabrics have a dark gray color with a fetid smell.When probing the affected area revealed crepitus due to the presence of gas fumes.
All of the above forms of cellulitis are keen for and are often malignant character.They spread rapidly, capturing new areas with fatty tissue.Cellulitis accompanied by severe intoxication.
Chronic cellulitis may occur at low virulence pathogens and increased resistance of the patient.Accompanied by the development of woody infiltration, dense to the touch.The skin in the area of inflammation are bluish tint.
Cellulitis and abscess
called localized abscess purulent inflammation of soft tissues.Phlegmon called extensive pyonecrotic nature inflammation of adipose tissue, the spaces interfascial and other soft tissues.
Activators of abscesses and abscesses presented staphylococcal infections, streptococcal infections, at least E. coli, Pseudomonas aeruginosa, and anaerobes.Development and course of infection occurs through contact with the current lymph.
The symptoms abscesses and abscesses are acute and subacute stage of the stage.The sharp rise is characterized by local signs of inflammation (redness, swelling, pain, the development of infiltrates) expressed general intoxication reactions.If there is no timely opening of purulent exudate, the inflammatory process extends to the neighboring regions, which is fraught with the development of sepsis, meningitis, etc.
There may be a simultaneous development of abscesses and abscesses that brings great suffering to the patient.His condition may have deteriorated sharply.This condition is accompanied by fever, pain in the affected area with a pulsating character of pain, nausea and vomiting, pale skin.The blood is determined by elevated levels of C-reactive protein, leukocytosis, increased erythrocyte sedimentation rate increased, decreased hemoglobin level and red blood cells.Lowering the level of hemoglobin is associated with secondary anemia that develops against the backdrop of the intoxication process.If you do not appoint such a patient emergency treatment, there can be a rapid development of sepsis deaths.Therefore, when connecting the common syndromes of intoxication, you should immediately call an ambulance for hospital patients with abscesses and phlegmon.
therapy of this kind of education is a wide opening and drainage of inflammatory foci.Sometimes we have to make a few cuts in the affected area, leaving a large gaping wound deep cavity.The need for daily washing of the wound cavity with antiseptic solutions, the appointment of passive and active immunization, administration of hormone therapy, and desensitizing holding infusion detoxification therapy.
surgical procedure the patient brings good relief.Although after the intervention produced an extensive wound, it does not cause a sharp pain to the patient.This is due to emptying of purulent content from it.The patient may even move his limbs (in phlegmon and abscesses on the thigh or arm).There is a drop in body temperature to subfebrile figures.The use of antimicrobials in the first few days of infection and promotes the excretion of reduction in body temperature.
After opening the abscesses and abscesses need to daily monitor the state of the wound site, and the general condition of the patient, blood pressure, urine output.After the acute inflammation subsided expedient appointment of physiotherapy (electrophoresis, microwave, UFO, UHF, etc.).
neck Cellulitis is defined as a disease with a protracted course, in which the observed damage and interfascial mezhkletchatochnyh spaces neck.In the presence of cellulitis of the neck there is also filled with purulent contents interfascial certain spaces (subcutaneous abscess of the neck, neck and intermuscular abscess interfascial neck abscess).Due to the complex anatomy of the neck, cellulitis may have a different arrangement.Phlegmon unlike abscesses which developed in the neck, do not have clear flexible walls and thus limited fascia.
in phlegmon of the neck, the pus spreads from one space to another interfascial, promoting poured vast areas of destruction.Pathogens of purulent-inflammatory process can easily spread interfascial tissue, damaging the muscles, blood vessels, connective tissue and lymph nodes.
Typically, neck abscess occurs due to the complicated course catarrhal tonsillitis, peritonsillar dissection and retropharyngeal abscesses.It may also be due to the development of alveolitis, periodontitis and mandibular osteomyelitis, otitis, traumas.Penetration of the pathogen cellulitis in fatty tissue may occur in various ways: hematogenous way lymphogenous way, the penetration of pus inflammation of the nearby areas.Pathogens in phlegmon of the neck may be a variety of microorganisms: Streptococcus hemolytic group A, Staphylococcus, E. coli, klastridii, Pseudomonas aeruginosa.
For small phlegmons or phlegmons, deep-lying, outer skin manifestations in the neck may be absent.The body temperature is substantially not increased more than subfebrile.Manifestations of intoxication syndrome are mild.But the external or extensive cellulitis of the neck to reveal much easier.On the surface of the skin in the neck there is a marked redness, swelling and tenderness.During the palpation of subcutaneous cellulitis on her neck, determined fluctuation and soreness accompanied by tensions skin.The general condition of the patient is represented as severe or moderately gravity.
Also, when phlegmons neck patients complained of difficulty in swallowing and breathing, especially when squeezed phlegmon of the pharynx or esophagus.When the form of cellulitis submandibular neck, difficult mouth opening and chewing food.The mouth is then in the half-open state, from it came the putrid smell.With the development of the disease and the patient's condition may deteriorate significantly.When cellulitis neck shows only surgery with drainage of purulent foci in the hospital.
Phlegmon brush is defined as purulent inflammation of superficial or deep soft tissues of the hand without limiting the spread of the inflammatory process.Provoking factor of phlegmon brush is considered to be non-specific pyogenic microflora, which falls into the fabric brushes in different ways.
primary suppurative focus may be located proximal to the fabric brush, with pathogens on the vaginal interfascial pass into the thickness of soft tissue hand, developing in them the inflammatory process.Cellulitis can be a complication of the brush felon, as well as a variety of inflammatory diseases of the skin on the hand.