Abscess of soft fabrics is the cavity located in muscles or hypodermic fatty cellulose, delimited from surrounding fabrics and filled with purulent contents. It is characterized by existence of hypostasis, hyperaemia, morbidity of skin and symptom of fluctuation in a defeat zone. Is followed by all-somatic changes: headache, hyperthermia, indisposition, frustration of a dream. Inspection includes survey, ultrasonography, a X-ray analysis, a diagnostic puncture of abscess and a bacteriological research of its contents. After formation of abscess its opening with the subsequent postoperative drainage and washing by solutions of anti-septic tanks is made.
Abscess of soft fabrics
Abscess of soft fabrics differs from other pyoinflammatory diseases of existence of the infiltrative capsule or as it is called still, a piogenny membrane. Abscesses of any localizations have the similar capsule, including - located in internals. The capsule of abscess of soft fabrics limits it from a number of the located anatomical structures and interferes with distribution of purulent process. However accumulation of a significant amount of purulent exudate, increase in abscess and thinning of its capsule can lead to break of abscess of soft fabrics with an exit of its purulent contents in surrounding cellulose or intermuscular spaces with development of the poured purulent inflammation — phlegmons.
Pathological process is caused by hit in fabric of gnoyerodny microorganisms. Approximately in a quarter of cases abscess of soft fabrics is caused by a staphylococcal infection. Streptococci, colibacillus, proteas, a sinegnoyny stick, klostridiya and so forth pathogenic microorganisms can also be activators. Often abscess of soft fabrics has a polymicrobic etiology. At bone tuberculosis the "cold" abscess of soft fabrics caused by tuberculosis mikobakteriya can be observed.
Penetration of the gnoyerodny microorganisms causing abscess of soft fabrics results at violation of integrity of an integument from wounds, injuries, microinjuries, burns, freezing injuries, open changes more often. Abscess of soft fabrics can arise at distribution of microorganisms in the limfogenny and hematogenic way from the purulent centers which are available in an organism. For example, furuncle, anthrax, piodermiya and so forth. Infection can happen in the yatrogenny way when carrying out an injection to formation of abscess of soft fabrics the infected needle. The aseptic abscess of soft fabrics resulting from hit in fabric of the liquids causing their necrosis is in rare instances observed (kerosene, gasoline, etc.).
The background favoring to development of abscess of soft fabrics is existence in an organism of the center of a chronic infection (sinusitis, chronic tonsillitis, pharyngitis.), it is long the proceeding disease of digestive tract, disorders of peripheral blood circulation and exchange violations (obesity, a hypothyroidism, avitaminosis). Especially significant role in development and progressing of purulent process is played by diabetes with the expressed angiopatiya.
Abscess of soft fabrics is characterized by existence of local and all-somatic symptoms. Morbidity, a swelling and reddening of the site of skin located over abscess belongs to local signs. Pressing in the struck area causes strengthening of pain. If abscess of soft fabrics is located superficially, then the local symptomatology is distinctly expressed and is supplemented with the fluctuation symptom arising in several days after formation of abscess testifying to a congestion of liquid contents in the inflammatory center.
At deeply located abscess, its local symptoms are not so noticeable, fluctuation is not observed and to the forefront there can be changes in the general condition of the patient. All-somatic symptoms of abscess of soft fabrics have no specific character. Patients note increased fatigue, a periodic headache, weakness, a sleep disorder, rise in body temperature which can reach 39-40 °C and be followed by a fever.
The expressed symptoms of intoxication can be connected with absorption in a blood-groove of the toxic substances which are formed as a result of disintegration of fabrics in abscess or to confirm distribution of purulent process and threat of sepsis. Development of phlegmon of soft fabrics, purulent fusion of a wall of a nearby large vessel, involvement in process of a nervous trunk with development of neuritis, distribution of purulent process on firm stuktura by developing of osteomyelitis of a nearby bone can become a complication of abscess of soft fabrics, except sepsis.
During diagnostic inspection of the patient the purulent surgeon has to pay attention to existence in its anamnesis of the instruction to emergence of inflammatory symptoms after the postponed trauma, wound or an injection. Superficially located abscess of soft fabrics easily comes to light at survey of the struck area. Deeper abscesses demand purpose of a sonografiya of soft fabrics and a diagnostic puncture. After carrying out a puncture the received material is subjected to a bacteriological research for definition of sensitivity of gnoyerodny microflora to antibiotics.
At suspicion of "cold" abscess make radiological inspection of the struck area and PTsR-diagnosis of tuberculosis. Diagnose also background diseases of the patient for what consultations of adjacent experts can be required: otolaryngologist, gastroenterologist, endocrinologist.
Treatment of abscess of soft fabrics
In an initial stage conservative treatment is recommended: anti-inflammatory therapy and UVCh. The created abscess of soft fabrics is subject to obligatory surgical treatment. Opening and drainage is usually carried out by the surgeon in the out-patient operating room. Hospitalization is necessary in case of the complicated abscess, an abscess recurrence after the carried-out surgical treatment, existence of a serious background illness or a condition of the patient, the anaerobic nature of an infection, high risk of development of postoperative complications at an abscess arrangement on a face, near large vessels or nervous trunks.
In surgery the opened and closed expeditious treatment of abscess of soft fabrics is applied now. The closed way is made through a small section. It includes a curettage of walls and aspiration of contents of abscess, application of a dvuprosvetny tube for drainage, active aspiration and washing of a cavity after operation on opening of abscess. The open way of treatment provides depletion and washing of abscess an anti-septic tank after its wide section, drainage by means of wide strips, a daily postoperative toilet of a cavity of abscess and bandaging.
If opening and drainage of abscess does not lead to easing and gradual disappearance of all-somatic and intoksikatsionny symptoms, then it is necessary to think of generalization of a purulent infection and development of sepsis. In such cases performing massive antibacterial therapy, dezintoksikatsionny, infusional and symptomatic medical actions is necessary.
The prevention of formation of abscess in soft fabrics consists in observance of rules of an asepsis and technology of performance of injections, use only of disposable syringes and needles, timely treatment of purulent processes of various localization, increase in nonspecific resistance of an organism, adequate and careful preprocessing of wounds at traumatic damages.
1. Operational purulent surgery / Gostishchev of V. K.
2. Purulent surgery. Atlas / Goryunov S. V.
3. Surgical infections of skin and soft fabrics / Savelyev V. S.