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Surgical treatment consists in a wide dissection in conjunction with excision of dead tissue in order to remove dead skin lesions and on access for air . Amputation is used in cases of severe progressive intoxication. Postoperatively attention to the fight against toxicity , cardiovascular , hepatic insufficiency.
Carbuncle - an acute diffuse necrotic inflammation of multiple hair follicles and sebaceous glands to produce extensive necrosis of the skin and subcutaneous tissue . The most common sites of localization are carbuncle back of the neck , interscapular region, face , lower back , buttock , at least - the limb. Especially dangerous is the localization carbuncle on the face. The disease begins with the appearance of the rapidly increasing sharply painful inflammatory infiltrate , sometimes with superficial pustules in the center. The skin in the area of infiltration is purple , tense, swollen, gradually undergoes necrosis. Epidermis melts , it produces several holes through which stands thick yellow or greenish- gray pus. Expressed general intoxication . Marked headache, insomnia , nausea and sometimes delirium, the temperature rises to 40 ° C. In the pattern of blood leukocytosis with a left shift , elevated ESR. After the rejection of the common areas of necrosis phenomenon subsides , the wound is covered with granulation , after healing with scar formation area of pigmentation. Term formation of necrosis on average 3-4 days , disease duration - 4-5 weeks.
Management of patients :
in the initial stages of the inflammatory process required bed rest . Appointed by excessive drinking, lacto-vegetarian diet . Shows the use of painkillers and vitamins. With antibiotics parenterally and topically as chipping in solution of novocaine. Used UHF, electrophoresis solutions of antibiotics .
Surgical treatment is indicated in the failure of conservative treatment and progression of local and general symptoms. Produced cross sectional area with excision of necrotic to viable tissue .
Lymphadenitis - inflammation of the lymph nodes. Usually develops as a secondary disease . Sometimes, the primary focus remains unrecognized . The disease sometimes occurs with bleeding in the tissue nodes (hemorrhagic lymphadenitis ) . And an increase in the lymph gland , their tenderness . Lymph nodes are movable relative to the skin and underlying tissues . They gradually increase in volume and form stationary packages. Swelling above noted dermahemia . Later leather soldered to infiltrate. With the progression of the infiltration process softens at its center appears fluctuation . The skin becomes cyanotic , thins . Abscess may spontaneously defecate . Expressed phenomena of intoxication. Lymph nodes may remain for a long time increased . Decrease occurs gradually as the connective tissue resorption .
Management of patients :
In the initial period of the disease is necessary to ensure peace of the affected area of the body, apply heat , antibiotics. When expressed phenomena of intoxication held detoxification therapy ( drinking plenty of fluids , infusion fluids , blood transfusion ) .
Surgical treatment is shown in purulent lymphadenitis , abscess , cellulitis . Produced by opening the abscess and removal of dead tissue , followed by drainage cavity.
In order to prevent you must abide by the rules of sanitation and hygiene . On the surface of the body must be promptly eliminated sweat , dirt, especially in those physical labor, used clothes .
Lymphangitis - an acute inflammation of the lymph vessels. Often occurs in the extremities . Initially affects the small lymphatic vessels , and then the process involved large vessels . By the nature of the inflammatory process may be serous and purulent . The shape of the mesh can be lymphangitis and stem .
Management of patients :
disease begins a sharp rise in temperature , which has a permanent character , headache, chills . Locally marked swelling , redness, tenderness along the lymphatic vessels. When the mesh form an intense hyperemia without clear boundaries . Hyperemia seen against the background of a thin mesh pattern . When stem form noted the appearance of longitudinal red stripes . With the defeat of surface vessels palpation vessels sharply painful , tight . Marked a sharp pain , itching and burning . With the defeat of the deep vascular skin hyperemia was observed. Characterized by the appearance of swelling, pain , and early lymphadenitis .
Conservative treatment is to assign the rest of the affected area , the immobilization of the limb , giving her exalted position , an antibiotic . When expressed phenomena of intoxication held detoxification therapy ( drinking plenty of fluids , intravenous and subcutaneous administration of fluids , etc.). Topically apply a hot compress , fatty dressings .
Surgical treatment is indicated in complicated disease. Conducted an autopsy ulcer , provided the outflow of pus from the wound.
As a preventive measure must be timely performed primary processing damage lanced and drained purulent foci.
Mastitis - inflammation of the mammary gland. More common in nursing mothers , mainly in the first weeks after birth. Mastitis rarely develops in pregnant women in the last weeks before delivery , much less - the girls or women in menopause . Infection enters the breast tissue through the nipple skin , scratches , abrasions , in lymphatic penetrates into the interstitial tissue of the gland or milk moves - in the lobules . With the penetration of the infection through the teat skin damage process can sometimes restrict inflammation of the subcutaneous tissue and the formation of an abscess areola . Contribute to the development of mastitis blockage of the excretory ducts and milk stasis . Characteristic features are the rapid spread of mastitis process involving large areas of glandular tissue , weakly pronounced ability to the limit.
serous
infiltrative
abscessed
abscess
gangrenous
infiltrative
In the clinical course of the process stand out form : (initial) - is characterized by the appearance of pain in the breast, insomnia , chills , fever up to 39,5-40 ° C, loss of appetite . Iron uniformly increased , her skin is not changed. Should prevent stagnation of milk ; (acute ) - develops with the progression of the process. Temperature is maintained at high numbers, exacerbated pain , there weakness, chills, blood in the film increases leukocytosis up to 10 000-15 000 , increased ESR. Iron increases significantly when palpation painful infiltrate with indistinct borders . Hyperemic skin over them , increasing the regional lymph nodes ; - Develops in the absence of the effect of applied therapy. Common clinical manifestations are increasing , the temperature is kept at 39-40 ° C, enhanced chills . Locally, there was a sharp redness of the breast skin , subcutaneous venous network expansion , regional lymphadenitis . In the area of ​​infiltration is determined fluctuation ; - Is characterized by a sharp deterioration in the general condition. Skin cancer becomes cyanotic hue , shining, often retracted nipple , floating notes in several places ; - Observed in the late -treatment patients for medical help. In the mammary gland as a result of thrombosis and stagnation develops necrotic process . General condition of patients is extremely difficult . Mammary gland increased dramatically swollen, pasty , painful, her skin is pale green or blue- purple color , sometimes covered with bubbles in some areas - skin necrosis . Retracted nipple , milk is not available , greatly enlarged and painful regional lymph nodes ; ( chronic) - may develop after long-term topical antibiotics for acute purulent mastitis arisen . Mammary gland increased slightly in volume, determined by palpation is very tight ( cartilage density) infiltration, not soldered skin maloboleznenny . The skin over the infiltration is not changed, sometimes hyperemic, on the affected side palpable enlarged , mobile lymph nodes.
Management of patients :
conservative anti-inflammatory therapy is conducted on the general principles of treatment of purulent process .
Surgical treatment is used for abscess , abscess and gangrenous forms. It consists in opening the abscess .
Mastitis prevention is to prevent the formation of cracks and excoriations in the nipple , preventing stagnation of milk.