Felon


Fig. 2. Places injection for pain at the opening of the felon.

Subcutaneous felon - cellulitis subcutaneous tissue Palmar surface of the finger. In connection with thick and rough skin in the field of pus not able to break through, while the construction of fiber finger promotes process in depth on the tendon sheath, bone or joint. Thus, launched subcutaneous felon - the main reason for the development of other forms of deep felon. The weight of all deep forms of felon especially increased by the fact that the skin of the finger is very stubborn, and at swelling underlying tissue is the compression of feeding blood vessels and quickly come necrotic changes. Signs of subcutaneous felon: severe pain, swelling initially minor, the presence of a sharp pain at first on a small area (sore point is identified with a gentle pressure with the tip of the probe). The pain intensifies, deprive the patient of sleep, increased swelling of the phalanx, it becomes painful. Treatment: hot baths, compresses, and so on, can be applied only in a very early stage. The first night spent in patients without sleep,the indications for the immediate opening of a felon. Best of all, if the patient from the beginning is under the supervision of the surgeon. Operation make sure with reliable anesthesia under Rausch-anesthesia (short-term) or more procaine under local anesthesia (Fig. 2). On the sides of the main phalanx impose on each side of 1.5-2 ml of 2% solution novokaina, bringing the needle to the bone and gradually removing it. The pain occurs in 3-5 minutes the Incision is performed through the most painful point in the entire thickness of the subcutaneous tissue. The wound is drained by a strip of rubber glove, dressings with a 10% solution of sodium chloride, limb certainly immobilizer bus (gypsum Longuet). Daily - bandage change in a warm bath of antiseptic solution, hypertensive dressing. After remitting inflammatory phenomena - Vishnevsky ointment. Late treatment the patient sometimes pus can break through the skin beneath the epidermis, creating a bubble. Such "zaporotsky" abscess may be accepted for skin felon. To avoid this dangerous errors, you need at the opening of the bubble always carefully examine its bottom - whether it is a narrow hole leading into the depths. In this case the need for a deep cut, as described above.
Tendon felon - purulent inflammation of the tendon sheath finger (see Tendonitis). On the tendon sheath pus spreads quickly on the palm of the hand and the wrist, threatens a heavy defeat all brushes (see Brush, inflammatory diseases). With thumb process can go on the little finger, and Vice versa - with the little finger on the first finger, as their tendon sheath reported. This so-called cross-felon. The main characteristic of the tendon felon - half-bent position of the finger, and a sharp pain when trying extension. The patient should immediately be sent to the surgeon, putting a hand on the bus. Treatment: in the early stages effective injection solution of penicillin in tendon sheath. In the absence of success - cuts. Launched tendon felon even after successful treatment leads to contractions.
Bone felon - osteomyelitis of the phalanx. The defeat bones detected by x-ray or detected when the cut. Treatment consists of removal of the affected part of the bone, and sometimes the whole phalanx.
Joint felon - purulent arthritis interphalangeal joint. Manifested by swelling, stiffness, sharp painful joints.
Treatment: opening of the joint, immobilization, antibiotics, usually ends with the joint ankylosis.
The most dangerous (rare) form - lymph felon, which purulent centre in place of micro-injuries in General is not formed, but it is the rapid spread of infection through the lymph system fingers, hands and forearms, threatening sepsis. Signs: swelling of the fingers and hands, strip lymphangitis, severe General condition of the patient - chills, fever of 40 degrees and above. You energetic protivosepticheskie treatment in hospital (see Sepsis). Operation is not required.
Prevention of felon is to guard against damage (gloves at work associated with injury), the immediate removing splinters, processing scratches, abrasions iodine tincture, etc.