Felon – the sharp purulent inflammatory process which is localized in tissues of fingers of hands (is more rare – toes) and arising on the palmar surface of fingers. Purulent inflammations on the back surface of fingers do not belong to felons, except for processes in a nail. Most often the disease develops at penetration of microbes through grazes and small wounds which sometimes can remain unnoticed. The felon is shown by pain, hypostasis, reddening. At initial stages perhaps conservative treatment. When forming an abscess operation is necessary. Features of a structure and an arrangement of soft fabrics in this area promote spread of suppuration to depth – to bones, joints and sinews. For lack of treatment serious complications therefore at suspicion on a felon it is necessary to see a doctor immediately are possible.
Felon – sharp suppuration of fingers of hands (is more rare – toes). Develops as a result of activity of the gnoyerodny microorganisms (most often – golden staphylococcus) getting into fabrics through small injuries of skin. At a felon hypostasis, reddening and pains in a finger are noted. At severe forms the fever and temperature increase is observed. Pains can be sharp, pulsing, depriving of a dream. At early stages perhaps conservative treatment, on late – operation is necessary.
The felon is more often observed at children, and also persons of young and middle age – from 20 to 50 years. Statistically, three quarters of patients get sick after the microtrauma got on production. The most widespread localization are I, II and III fingers of the right brush. Development of a felon is promoted as external (cooling, vibration, influence of chemicals), and internal (immunity easing) by factors.
On the palmar surface of fingers the set of important anatomic educations is located: sinews and tendinous vaginas, nerves, vessels, capsules of joints etc. Hypodermic cellulose in this area has a special structure. From skin to a palmar aponeurosis there are numerous elastic and strong fibers. Besides, in the thickness of cellulose longitudinal bunches of connecting fabric settle down. As a result cellulose is divided into the small cells reminding bee honeycombs.
Such structure, on the one hand, interferes with distribution of an inflammation "lengthways", with another – creates favorable conditions for penetration of purulent process deep into of fabrics. For this reason at a felon perhaps bystry progressing with involvement of sinews, bones and joints or even all tissues of a finger.
Taking into account a location and character of the struck fabrics allocate the following types of a felon:
- Skin felon. The easiest form. The abscess is formed in the thickness of skin.
- Okolonogteva felon (paronychia). The inflammation is localized in the field of the okolonogtevy roller.
- Subnail felon. Develops under a nail plate.
- Hypodermic felon. Arises in hypodermic cellulose of a palmar surface of fingers.
- Bone felon. Distinctive feature is involvement in purulent process of a bone.
- Articulate felon. Develops in interphalanx or pyastno-phalanx joints.
- Bone and articulate felon. Usually arises when progressing an articulate felon when the inflammation passes to the articulate ends of bones of phalanxes.
- Tendinous felon. It is localized in a sinew.
The golden staphylococcus getting into fabrics through wounds, grazes, pricks, cracks, splinters or agnails which sometimes remain unnoticed becomes an immediate cause of emergence of a felon most often or look so insignificant that the patient simply does not pay attention to them. Less often the felon is caused by a gramotritsatelny and gramolozhitelny stick, a streptococcus, colibacillus, Proteus, and also anaerobic neklostridialny microflora and causative agents of a putrefactive infection.
Systematic cooling, moistening, vibration, maceration, pollution or influence of the irritating substances belongs to number of the external factors promoting development of a felon. The internal factors increasing probability of emergence of a felon are endocrine diseases, hypovitaminoses, metabolic disorders and decrease in immunity.
Symptoms of a felon can differ depending on a disease form. Nevertheless, at any forms a number of the general symptoms is observed. At initial stages of a felon reddening, insignificant hypostasis and weak or moderate pain is noted, it is possible - burning. Then hypostasis increases, pains amplify, become intensive, holding apart, pulling, depriving of a dream.
In the field of an inflammation the purulent center which is well visible at superficial forms of a felon is formed. Formation of an abscess can be followed by weakness, fatigue, a headache and temperature increase of a body. Symptoms of intoxication are more brightly expressed at deep, severe forms of a felon (bone, articulate, tendinous).
Besides, each form of a felon has characteristic symptoms.
The skin felon usually arises in a nail phalanx. Skin reddens, then in the center of reddening the limited site of epidermis exfoliates. The bubble filled with the muddy, bloody or grayish-yellow liquid translucent through skin is formed. In the beginning pains unsharp, then they gradually amplify, become pulsing. This form of a felon often is followed by a stem limfangit at which on a forearm and a brush red strips on the course of the inflamed lymph nodes are formed. At an uncomplicated felon the general state does not suffer, at a limfangita temperature increase, weakness, weakness is possible.
Okolonogteva the felon (paronychia), as a rule, develops after unsuccessful manicure or is a complication of agnails and cracks of the okolonogtevy roller at people of physical work. In the beginning local hypostasis and reddening is noted, then process quickly extends, covering all nail roller. The abscess translucent through thin skin of this area is quickly enough formed. In the field of an inflammation there are severe pains interrupting a sleep, however the general state almost does not suffer. Limfangit at this form of a felon it is observed seldom.
Perhaps spontaneous opening of an abscess, however its incomplete depletion can become the reason of transition of a sharp form of a felon in chronic. When progressing process pus can break under the nail basis, extend in hypodermic cellulose of palmar area, to a bone and even a distalny interphalanx joint.
Subnail felon. Usually is a paronychia complication, however, can develop and initially – as a result of a splinter, a chipped wound in the field of free edge of a nail or at suppuration of a subnail hematoma. As the formed abscess in this area "is pressed down" by a rigid and dense nail plate, extremely intensive pains, a general malaise and substantial increase of temperature are characteristic of a subnail felon. The nail phalanx is edematous, under a nail illuminates pus.
Hypodermic felon. The most widespread type of felons. Usually develops at infection of small, but deep chipped wounds (for example, at a prick a plant thorn, a pricker, a fish bone etc.). In the beginning there is a small reddening and local pain. Within several hours pain amplifies, becomes pulsing. The finger swells. The general condition of the patient can how to remain satisfactory, and considerably to worsen. At the abscesses which are under big pressure oznoba and temperature increase to 38 degrees and are noted above. In the absence of treatment, insufficient or late treatment distribution of purulent process on deep anatomic educations (bones, joints, sinews) is possible.
Bone felon. Can develop at the infected open change or turn out to be consequence of a hypodermic felon at spread of an infection from soft fabrics on a bone. Prevalence of processes of fusion of a bone (osteomyelitis) over its restoration is characteristic. Perhaps both partial, and final fracture of a phalanx. At early stages symptoms remind a hypodermic felon, however, are expressed much more brightly. The patient suffers from extremely intensive pulsing pains, cannot sleep.
The affected phalanx increases in the volume because of what the finger takes a kolboobrazny form. Skin is smooth, brilliant, red with a tsianotichny shade. The finger is slightly bent, the movements are limited because of pain. Unlike a hypodermic felon at a bone form it is impossible to define the site of the maximum morbidity as pain has poured character. The fever and fever is noted.
Articulate felon. Can develop as a result of direct infection (at the getting wounds or open intra articulate fractures) or distribution of purulent process (at a tendinous, hypodermic and bone felon). In the beginning there is small hypostasis and joint pain at the movements.
Then pain amplifies, the movements become impossible. Hypostasis increases and becomes especially expressed on the back surface of a finger. At a palpation joint capsule tension is defined. In the subsequent on the back of a finger fistula is formed. Primary felons can come to an end with recovery, at the secondary felons (caused by spread of suppuration from the next fabrics) amputation or an anchylosis becomes an outcome usually.
The tendinous felon (purulent tendovaginit), as well as other types of a felon, can develop both at direct penetration of an infection, and at its distribution from other departments of a finger. The finger is evenly edematous, is slightly bent, the intensive pains which are sharply amplifying in attempt of passive movements are noted. With a pressure sharp morbidity is determined by the course of a sinew. Reddening can be not expressed. Substantial increase of temperature, weakness, lack of appetite is noted. Confusion of consciousness and nonsense are possible.
Tendinous felon – the heaviest and dangerous purulent inflammation of a finger. It is caused by the fact that pus quickly spreads on tendinous vaginas, passing to muscles, bones, soft tissues of a palm and even forearm. In the absence of treatment the sinew completely melts, and the finger loses the function.
The diagnosis is exposed on the basis of complaints of the patient and clinical symptoms of a disease. For definition of a form of a felon and specification of localization of an abscess the palpation is carried out by the pugovchaty probe. For an exception of a bone and articulate felon carry out a X-ray analysis. At the same time it is necessary to consider that, unlike a bone felon, at an articulate form of a disease of change come to light not at once and can be poorly expressed. Therefore for specification of the diagnosis it is necessary to appoint comparative roentgenograms of the healthy finger of the same name on other hand.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Surgeons are engaged in treatment of felons. At superficial forms the patient can be on the out-patient mode, at deep hospitalization is necessary. At early stages to patients with a superficial felon conservative therapy can be appointed: , UVCh, thermal procedures. At late stages of a superficial felon, and also at all stages of a bone and tendinous form of a disease operation is shown. Opening of a felon is supplemented with drainage so that to provide the most effective outflow from the cellulose divided into cells.
Surgical tactics at a bone or articulate felon is defined by degree of safety of the struck fabrics. At partial destruction carry out a resection of the damaged sites. At total destruction (it is possible at a bone and bone and articulate felon) amputation is shown. The medicinal therapy directed to fight against an inflammation (antibiotics), reduction of pains and elimination of the phenomena of the general intoxication is in parallel carried out.