Why is pus formed? Causes and types of suppuration. How to treat suppuration? Suppuration A purulent wound on the abdomen in a person

Infectious complications of wounds. Purulent wounds. Clinical picture festering wounds. Microflora. General and local reaction of the body. principles of general and local treatment festering wounds.

Surgical infection is the main type of postoperative complications, reaching 30% in surgical interventions, with wound infection being the most common.

Purulent wound.

Each wound serves as an open gate for the penetration of bacterial microflora. Whether or not a wound infection develops depends on several factors:

Type of infection (pathogenic, opportunistic and non-pathogenic bacteria).

Depending on the type of microorganisms, pyogenic (pyogenic, putrefactive) and anaerobic non-clostridial are distinguished.

Anaerobic clostridial (gas gangrene) and bacterial-toxic (tetanus) and specific (tuberculosis, actinomycosis, etc.) wound infection are also isolated.

Pyogenic infection (staphylococcus, streptococcus, gonococcus, etc.) is characterized by the formation of copious exudate of a purulent nature. Along with leukocytes, pus contains lymphocytes, erythrocytes, histiocytes, bacteria, decay products of necrotic tissues.

Clinical picture presented with all the typical signs of inflammation.

The putrefactive infection (Proteus vulgaris, Str.pyogenes, E.coli) significantly exceeds the pyogenic one in terms of the speed of spread and severity. Sometimes in a putrefactive (ichorous) secret gas formation is detected (not to be confused with anaerobic gas infection).

Clinical picture characterized by the rapid spread of the formation of serous exudate with a moderate content of leukocytes and an admixture of a large number of erythrocytes. Then the serous exudate becomes cloudy, necrosis of infiltrated tissues begins, ending with putrefactive decay.

Non-clostridial anaerobic infection (Bacteroides fragilis, Bacteroides melaninogenicus, etc.) Pathogens are an integral part of the normal microflora of the oral cavity, intestines, and external genital organs of a person. Operations on these organs can cause severe surgical infection.

Clinical picture characterized by severe intoxication, the presence of a scanty, brownish color, fetid exudate with gas bubbles. At first, the infection develops slowly (pastosity, hyperemia) and then can quickly cause necrosis of the tendon fascia, and then endotoxic shock.

The number of bacteria.

Less than 10 5 bacteria per 1 g of tissues is usually insufficient for the development of a wound infection. The presence of blood, serum, foreign bodies, earth, necrotic tissues, suture material lowers this threshold.

The degree of virulence of bacteria.

Virulence is the degree of pathogenicity of bacteria, which is determined by their ability to multiply in the host organism, causing disease.

Incubation period (6 - 8 hours - P.L. Friedrich, 1898).

Between the moment the bacteria enters the wound and the clinical development of the wound infection, time passes, during which some adapt to the new environment, others multiply, and still others only come out of their spores. When the source of pathogens are animals or humans, bacteria are instantly ready for reproduction and aggressive action. Therefore, bite wounds, wounds contaminated with intestinal contents, obtained during cutting meat are extremely dangerous.

Wound localization.

Different parts of the human body, depending on their blood supply, are characterized by different susceptibility to infection. High predisposition to infection in subcutaneous adipose tissue, internal articular membranes, pleura, tendon fibers.

The state of the body's defenses.

The infectious process in the wound develops when the balance between the bacteria that pollute the wound and the protective forces of the macroorganism is disturbed. Resistance may decrease with diabetes mellitus, anemia, protein deficiency, hypovitaminosis, due to age and concomitant diseases.

Clinical picture

The clinical picture of wound suppuration is manifested by a combination of local and general signs of inflammation.

The general reaction of the body is expressed in proportion to the scale and nature of the local purulent process.

Intoxication appears in the first phase of the wound process. General weakness increases, chills, sweating, lack of appetite, headache appear.

Pain in the wound intensifies, often taking on a pulsating, twitching character (a sleepless night due to pain in the wound is an indication for emergency surgical care).

The temperature steadfastly stays at high numbers (38 - 39 0 C), often takes on a hectic character (an increase in body temperature directly indicates the presence of suppuration, and serves as an indication for revision of the wound). A dynamic study of the blood picture reveals an increase in ESR, leukocytosis, a shift of the leukocyte formula to the left, and lymphocytopenia.

Locally, with the development of suppuration, swelling and tissue infiltration, skin hyperemia, and local hyperthermia are observed. Often, the skin edges of the wound diverge and the discharge of purulent discharge begins. Purulent inflammation may be accompanied by lymphangitis and lymphadenitis. It must be remembered that, depending on the type of pathogen, the localization of the process (the depth of the wound), any individual symptom of inflammation may predominate in the clinical picture. In some cases, the purulent process can proceed atypically (massive antibiotic therapy, severe concomitant diseases, etc.). Often there is a sluggish, oligosymptomatic development of suppuration (hypoergic), in which general and local changes are slightly expressed. However, the presence of even mild symptoms of suppuration in a patient requires the doctor's alertness. Less commonly, a stormy clinical picture (hyperergic course) can be observed, which is not difficult to diagnose.

Treatment of purulent wounds

General treatment.

1. Antibacterial therapy is carried out taking into account the sensitivity of pathogens. The dose of the antibiotic should exceed the minimum inhibitory concentration in the blood. Their use should be long enough, taking into account individual tolerance, both at the beginning and during the treatment. Antibacterial treatment is started immediately, without waiting for a response from the laboratory about the qualitative composition of the microflora, and its sensitivity to antibiotics. Until the results of the study are obtained, antibiotics with the widest possible spectrum of action are prescribed. After determining the sensitivity, the antibiotic can be changed to a more effective one. Antibacterial therapy should be continued until stable clinical and laboratory well-being.

2. Detoxification is carried out using the following methods:

infusion of saline solutions (introduced in / in - physiological saline, Ringer's solution, 5% glucose solution),

forced diuresis method (injected intravenous crystalloid solutions at the rate of 50-70 ml/kg/day, diuresis is maintained at a volume of 100 ml/hour by introducing 40-200 mg of furosemide or manitol - 1 g/kg),

the use of detoxification solutions (hemodez, neocompensan, etc.),

extracorporeal detoxification methods:

a) sorption methods (hemosorption, plasmasorption, lymphosorption) include - filtration through columns with sorbents (coal, ion-exchange resins, etc.) and xenoselenium of the corresponding biological fluids;

b) the extraction method (plasmapheresis) is based on the removal of toxic blood plasma from the body and its replacement with blood-substituting solutions and donor plasma;

c) drainage of the thoracic lymphatic duct allows you to remove lymph, the toxicity of which significantly exceeds the toxicity of plasma (2-3 liters of lymph enter through the catheter per day, which is replaced with blood substitutes and donor plasma);

d) chemical oxidation of blood toxins by intravenous sodium hypochlorite (0.1%) and ozonized solution (100 µg/l);

e) quantum irradiation of blood using low-energy laser systems and devices for UV irradiation of blood.

3. Immunocorrective therapy is carried out with a decrease in the level of immunoglobulins, phagocytic activity of cells, a deficiency of lymphocyte subpopulations and a slowdown in their differentiation.

Currently, low-energy laser radiation, thymus preparations, interferons, interleukins, etc. are most widely used.

4. Symptomatic therapy is carried out according to the relevant indications.

local treatment.

I. Phase of inflammation (hydration).

1. Secondary surgical treatment (SDO) of the wound is performed in the presence of a purulent focus, the absence of adequate outflow from the wound, the formation of extensive areas of necrosis and purulent streaks. The purpose of WMO is to eliminate suppuration and prevent the spread of wound infection.

Before WTO, it is necessary to conduct a thorough examination of the patient using additional research methods (ultrasound, radiography, including computed tomography, thermoscopy, etc.). WTO is an independent surgical intervention and is performed in the operating room by a team of surgeons using adequate anesthesia.

VMO provides for: a) opening of purulent foci and streaks b) excision of non-viable tissues c) adequate drainage of the wound

The wound is not sutured (subsequently, secondary sutures may be applied)

2. Treatment after VMO (or after removal of sutures and dilution of the edges of a purulent wound) consists in taking measures aimed at combating microorganisms, adequate drainage and prompt cleansing of necrotic tissues:

daily wound toilet,

the use of dressings with water-soluble antiseptics (chlorhexidine, iodopyrone, sodium hypochlorite, boric acid, dioxidine, etc.),

application of dressings with hypertonic solution (NaCl 10%),

the use of ointments on a hydrophilic basis ("Levosin", "Levonorsin", Sulfamekol, "Dioksikol", "Levomekol"),

the use of dressings with proteolytic enzymes (trypsin, chymotrypsin, chymopsin, etc.),

local application of gel sorbents ("Gelevin", "Sephadex", "Biogel", "Molselect") and carbon-containing (polyphepan, actilen, etc.),

passive and active drainage of wounds with the help of rubber and plastic tubes and "boats".

In order to increase the effectiveness of the treatment of purulent wounds, physical and mixed antiseptic methods are widely used:

ultrasonic wound cavitation,

vacuum treatment of purulent cavities,

processing with high-energy laser radiation (CO 2 - laser, helium-cadmium laser, etc.),

flow-aspiration closed wound drainage,

treatment with a pulsating antiseptic jet,

hydropressive ozone sanitation of purulent wounds and cavities,

treatment in a controlled antibacterial environment in general and local isolators (t 26 - 32 0 C, pressure 5 - 15 mm Hg, relative humidity 50 - 65%),

UHF, UVI, electro- and phonophoresis with antibiotics.

II. The regeneration phase, the phase of scar formation and reorganization (dehydration).

The main objectives of treatment in the regeneration phase are to suppress infection and stimulate reparative processes.

Fat-based ointments, emulsions and liniments are used, which also include antibacterial substances (erythromycin ointment, gentamicin, tetracycline, synthomycin, furatsilin, etc.) and substances that stimulate regeneration, epithelialization (Solcoseryl ointment, Actovegin, etc. ). Widely used are multicomponent fat-based ointments that stimulate regeneration and contain anti-inflammatory substances (“Oxycyclozol”, “Oxyzon”, balsamic liniment according to A.A. Vishnevsky, etc.)

The imposition of secondary sutures is widely used, and in case of extensive defects, the closure of the wound surface with a split skin flap.

In order to activate reparative processes and epithelialization, laser therapy, magnetic therapy, and UV irradiation are used.

A frequent pathology with which surgeons are treated is a purulent wound. This condition requires timely and adequate treatment to avoid serious consequences. In the treatment of purulent formation, antibacterial agents are used that suppress dangerous microflora and contribute to its purification. In addition, it is advisable symptomatic treatment aimed at eliminating pathological symptoms.

In this section you will find answers to such questions: what are the causes and symptoms of infection of injuries, how to treat purulent wounds, what drugs can be used, how to smear a purulent wound, how to properly bandage a suppurating wound and find answers to other equally important questions of interest to you .

Causes of suppuration of the wound

Any wound can fester. The process of suppuration develops under the following conditions:

• Contamination of the wound, the ingress of foreign bodies into it. This contributes to a significant seeding of the wound with bacteria;
• Large area of ​​damage, crushing of soft tissues, stab wound with a narrow and long stroke;
• The presence of areas of necrosis (dead tissue), blood clots in large quantities.

In modern surgery, there are several main reasons that provoke the development of a purulent injury:

Symptoms of infection

The clinical picture of a purulent wound is very characteristic. Specialists identify both local and general symptoms, the severity of which depends on the type and size of the injury.

Local features include:

• Purulent discharge is visualized in the lumen of the injured area. Their color can be from light yellow to brown. It depends on the causative agent of the infection (staphylococcus, streptococcus, E. coli, fungi, and so on);
• intense pain. In the presence of an unopened abscess or streak, it has a pulsating character. Sometimes the pain is unbearable;
• Hyperemia(redness) in the area of ​​damage;
• Swelling of the surrounding soft tissues;
• local hyperthermia, that is, the skin around the wound is hot to the touch;
• If a limb is damaged, then its functions are severely impaired.

General signs of pathology are characterized by a violation of the patient's condition:

• Weakness, lethargy;
• General hyperthermia - an increase in body temperature, which is accompanied by chills;

• Decreased appetite or its complete absence;
• Nausea;
• A laboratory blood test reveals signs of inflammation; leukocytosis (increase in the number of leukocytes), accelerated ESR (erythrocyte sedimentation rate).

How to remove pus from a wound

For processing to be effective, it is necessary. If there is little pus, then you can simply wash the wound with solutions. However, when copious secretions the contents of the injury should be drawn out. For this purpose, drains can be used.

Drainage happens:

Local preparations are aimed at preventing the spread of purulent infection of wounds throughout the body. In the event that this type of therapy does not have the desired effect or complications develop, general treatment using systemic action is indicated.

The most commonly used drugs are the following groups:

• tetracyclines (doxycycline);
• Semi-synthetic penicillins (Ampioks, Ampicillin);
• Macrolides (Azithromycin, Clarithromycin);
• Aminoglycosides (Gentamicin, Isepamycin).

Systemic antibacterial drugs available in the form of capsules, tablets, and solutions and powders for injection. What shape medicinal product the attending physician decides to apply in this or that situation.

When the infection has spread significantly, parenteral administration of antibiotics is indicated. In severe cases, they are administered intravenously.

It should be remembered that uncontrolled reception antibacterial agents leads to the adaptation of microorganisms to them and the emergence of resistant forms. That is why all appointments should be made by a doctor and only in the case when other methods of treatment do not work.

Wound dressing and dressing care

It is carried out 1 - 2 times a day, depending on its condition.

In some cases, an emergency dressing may be required:

• Significant contamination and wetting of the bandage;
• Appearance spotting, which are clearly visible on the bandages;
• Increased pain;
• If the bandage slipped and exposed the wound.

This manipulation is performed by a surgeon and a nurse. With pronounced pain, anesthesia is required.

Bandaging of a purulent wound:

During the day, it is necessary to control the bandage and monitor its condition.. It must be protected from moisture and contamination. If there is moderate soaking of the bandages with pus, then the nurse should bandage the bandage. In the event that the discharge is heavy or bloody, you should inform your doctor.

Folk methods of treatment

Justified in the presence of small wounds with a slight release of pus. Before using such methods, it is necessary to consult with the attending surgeon and exclude the presence of an allergy to the components.

For washing and processing use:

Aloe pulp has a good wound healing effect. The leaf of this plant should be washed, peeled and used whole or crushed (slurry). You need to change such a compress every 3 hours.

Onion and garlic have antiseptic and antibacterial properties, they are also used in the treatment of purulent wounds. They prepare a gruel, which is applied to the damage on a napkin. Such a compress should be secured with a bandage.

Possible Complications

Purulent wounds can lead to the development of complications:

• non-healing wound- if for a long time (longer than 7 days) there is no tendency to cleanse and heal;
• Lymphangitis- inflammation of the lymphatic vessels located near the injury. There are red patches on the skin. In this case, the infection goes beyond the wound surface;
• Lymphadenitis- the infection spreads to regional The lymph nodes. They increase in size (rounded formations are visualized) and hurt. There may be a slight increase in body temperature;
• Osteomyelitis- inflammation of the bone tissue. This condition develops when the infection penetrates deeper than the soft tissues;
• Sepsis- a general infection of the body, which is manifested by intoxication. In severe cases, there are signs of brain damage, coma.

seams of secondary.

.

hyperbaric oxygen therapy.

152. Infectious complications of wounds. Purulent wounds primary and secondary. General and local signs of suppuration of the wound.

Immediate: bleeding, shock, anemia. Nearest: ingress of microbes and inflammatory processes. Late: sepsis

Primary - suppuration of wounds after 3-5 days, secondary - at a later date.

Local: pain, swelling, edema, hyperemia. General: fever, chills, tachycardia, weakness, malaise, headache, loss of appetite

153. Treatment of a purulent wound depending on the phase of the course of the wound process.

Phase 1 - antibiotic therapy, enzyme therapy, drainage, ultrasonic cavitation, antiseptic solutions, change dressings frequently, necrectomy

Phase 2 - regeneration stimulating agents, strengthening therapy, change dressings less often.

154. Modern principles of surgical treatment of purulent wounds. Radical surgical treatment of a purulent wound.

Primary surgical treatment of the wound- the first surgical intervention for tissue damage. Primary H. o. R. must be comprehensive and comprehensive. Produced on the 1st day after the injury, it is called early, on the 2nd day - delayed, after 48 h from the moment of injury - late. Delayed and late H. o. R. are a necessary measure in case of mass admission of the wounded, when it is impossible to perform surgical treatment in the early stages for all those in need. Proper organization is essential medical triage, at which allocate wounded with the continuing bleeding, the imposed plaits, separations and extensive destructions of extremities, signs of a purulent and anaerobic infection requiring immediate H. about. R. For the rest of the wounded, debridement may be delayed. When transferring primary H. o. r at a later date, they will take measures that reduce the risk of infectious complications, prescribe antibacterial agents. With the help of antibiotics, only a temporary suppression of the vital activity of the wound microflora is possible, which makes it possible to delay, rather than prevent, the development of infectious complications. Injured in condition traumatic shock before H. o. R. carry out a set of anti-shock measures. Only with continued bleeding is it permissible to perform surgical debridement without delay while conducting anti-shock therapy.

The amount of surgery depends on the nature of the injury. Stab and cut wounds with minor tissue damage, but with the formation of hematomas or bleeding, are only subject to dissection in order to stop bleeding and decompress tissues. Large wounds, which can be processed without additional tissue dissection (for example, extensive tangential wounds), are subject only to excision, through and blind wounds, especially with multi-comminuted bone fractures, to dissection and excision. Wounds with complex architectonics of the wound channel, extensive damage to soft tissues and bones are dissected and excised; additional incisions and counter-openings are also made to provide better access to the wound channel and drainage of the wound.

Surgical treatment is carried out, strictly observing the rules of asepsis and antisepsis. The method of anesthesia is chosen taking into account the severity and localization of the wound, the duration and trauma of the operation, the severity of the general condition of the wounded.

Excision of the skin edges of the wound should be performed very sparingly; remove only non-viable, crushed areas of the skin. Then the aponeurosis is widely dissected, an additional incision is made in the region of the corners of the wound in the transverse direction so that the incision of the aponeurosis has a Z-shape. This is necessary so that the aponeurotic case does not compress the edematous muscles after injury and surgery. Next, the edges of the wound are bred with hooks and damaged non-viable muscles are excised, which are determined by the absence of bleeding, contractility and characteristic resistance (elasticity) of muscle tissue in them. When carrying out primary processing in the early stages after injury, it is often difficult to establish the boundaries of non-viable tissues; in addition, late tissue necrosis is possible, which may subsequently require re-treatment of the wound.

With forced delayed or late H. o. R. the boundaries of non-viable tissues are determined more precisely, which makes it possible to excise tissues within the outlined demarcations. As the tissues are excised, foreign bodies and loose small bone fragments are removed from the wound. If at X. about. R. large vessels or nerve trunks are found, they are carefully pushed aside with blunt hooks. Fragments of damaged bone, as a rule, are not processed, with the exception of sharp ends that can cause secondary trauma to soft tissues. Rare sutures are applied to the adjacent layer of intact muscles to cover the exposed bone in order to prevent acute traumatic osteomyelitis. Muscles also cover exposed major vessels and nerves to avoid vascular thrombosis and nerve death. In case of injuries of the hand, foot, face, genitals, distal parts of the forearm and lower leg, the tissues are excised especially sparingly, because. wide excision in these areas can lead to permanent dysfunction or to the formation of contractures and deformities. In combat conditions, H. o. R. supplement with reconstructive and restorative operations: suturing of blood vessels and nerves, fixation of bone fractures with metal structures, etc. In peacetime conditions, reconstructive and restorative operations are usually an integral part of the primary surgical treatment of wounds. The operation is completed by infiltration of the wound walls with antibiotic solutions, drainage. It is advisable to actively aspirate the wound discharge using silicone perforated tubes connected to vacuum devices. Active suction can be supplemented with wound irrigation antiseptic solution and the imposition of a primary suture on the wound, which is possible only with constant monitoring and treatment in a hospital.

The most essential errors at H. about. R.: excessive excision of unchanged skin in the wound area, insufficient wound dissection, making it impossible to make a reliable revision of the wound channel and complete excision of non-viable tissues, insufficient perseverance in search of the source of bleeding, tight tamponade of the wound for the purpose of hemostasis, the use of gauze tampons for draining wounds.

Secondary debridement carried out in cases where the primary treatment did not work. Indications for secondary H. o. R. are the development of a wound infection (anaerobic, purulent, putrefactive), purulent-resorptive fever or sepsis caused by delayed tissue discharge, purulent streaks, near-wound abscess or phlegmon. The volume of secondary surgical treatment of the wound may be different. Complete surgical treatment of a purulent wound involves its excision within healthy tissues. Often, however, anatomical and operational conditions (danger of damage to blood vessels, nerves, tendons, articular capsules) allow only partial surgical treatment of such a wound. When the inflammatory process is localized along the wound channel, the latter is widely (sometimes with an additional dissection of the wound) opened, the accumulation of pus is removed, and the foci of necrosis are excised. For the purpose of additional rehabilitation of the wound, it is treated with a pulsating jet of an antiseptic, laser beams, low-frequency ultrasound, as well as vacuuming. Subsequently, proteolytic enzymes, carbon sorbents are used in combination with parenteral administration of antibiotics. After complete cleansing of the wound, with good development of granulations, it is permissible to apply seams of secondary. With the development of anaerobic infection, secondary surgical treatment is carried out most radically, and the wound is not sutured. The treatment of the wound is completed by draining it with one or more silicone drainage tubes and suturing the wound.

The drainage system allows in the postoperative period to wash the wound cavity with antiseptics and actively drain the wound when vacuum aspiration is connected . Active aspiration-washing drainage of the wound can significantly reduce the time of its healing.

Treatment of wounds after their primary and secondary surgical treatment is carried out using antibacterial agents, immunotherapy, restorative therapy, proteolytic enzymes, antioxidants, ultrasound, etc. Effective treatment of the wounded in conditions of gnotobiological isolation, and in case of anaerobic infection - with the use of hyperbaric oxygen therapy

155. Additional physical methods of wound treatment. Flow-aspiration system. Enzyme therapy, antibiotic therapy. Features of treatment in the phase of reparative regeneration. Physiotherapy treatment.

Reparation phase - regeneration stimulating agents, strengthening therapy, dressings should be changed less frequently.

Enzyme therapy: improves microcirculation, promotes rapid rejection of necrosis, and granulation tissue is formed faster

Flow-aspiration system - drainage (pumping out of pus) with washing of the wound

Antibacterial therapy against a microorganism together with antifungal agents.

FL - promotes wound healing.

156. Ultrasonic, laboratory and other methods of monitoring the course of the wound process. Prevention of suppuration of postoperative wounds. Blood test, biochemical analysis, ultrasound, physiotherapy: UHF, X-ray. Prevention: timely treatment of the wound, washing with an aseptic solution, washing the drains.

If under any conditions in a non-standard environment, you get a wound, you need to properly treat it, otherwise you risk getting suppuration. A festering wound can lead to the most tragic consequences.

One of important factors The risk of suppuration is the ingress of foreign objects into the wound: earth, dirt, pieces of clothing and other other third-party inclusions. Under these conditions, there are all conditions for the development of suppuration. As practice and experience shows, any untreated wound, practically always leads to the fact that it is likely to fester.

Signs of suppuration

The development of infection in the earlier, characteristically determined by increased pain, pulsation and distension. Puffiness and hyperemia become noticeable, after which the separation of pus begins. The process of scarring can be largely inhibited by suppuration of the wound. In addition, this is a clear threat of the spread of infection, which is fraught with sepsis and can be fatal.

The most dangerous wounds putrid infection developed as a result of infection with gas gangrene, tetanus and rabies.

In addition to increased pain and swelling, there is also a change in the color of the tissues. Fibrinous clots acquire a dark gray color, and the amount of pus discharge increases.

If the course of the suppuration process worsens, the temperature can rise to 39 - 40 ° C, while signs of general intoxication will clearly be traced.

If in the absence pain in patients with chills, the addition of a putrefactive process should be suspected.

The process of treating a festering wound

Tools and materials used in the dressing of a purulent wound must be sterile or thoroughly disinfected.

Bandaging of purulent wounds should be carried out every day, and in the case of extensive suppuration that occurs against the background of severe intoxication, twice a day.

Mandatory dressing is carried out in case of obvious wetting. An additional indication for emergency dressing is increased pain in the wound.

When dressing, the first step is to remove the bandage and bandage. Since the lower layers of the bandage are infected, it should not be twisted, but cut with scissors without unwinding. The skin must be held, not allowing it to reach for the bandage. A bandage firmly dried to the wound should be soaked with a cotton-gauze swab moistened with hydrogen peroxide, furacilin or saline.

If capillary bleeding begins when the bandage is removed, this place is clamped with a sterile gauze napkin, and only after the blood stops, the skin around the wound is treated.

The area around the wound is treated with iodine or alcohol, and the site of the most festering wound is cleaned with sterile dry swabs, and after that it is thoroughly washed with an antiseptic solution, which can be chlorhexidine, hydrogen peroxide or collargol.

Necrotic areas of tissue that begin to exfoliate, carefully grasping with tweezers, cut off with sharp sterile scissors.

Like any other, purulent inflammation is the body's response to the impact of any irritant, aimed at limiting the pathological site, destroying provoking agents and restoring damage. The inflammatory response consists of three successive phases: injury, swelling, repair. It is the nature of the edema that determines the type of inflammation.

Purulent inflammation develops with the predominance of pathogenic pyogenic bacteria in the edematous fluid (exudate). It can be Pseudomonas aeruginosa and Escherichia coli, staphylo-, gono-, streptococci, Klebsiella, Proteus. The degree of contamination of the lesion with bacteria determines the likelihood and nature of the inflammatory reaction.

Pus is a liquid medium containing in its composition dead blood cells (leukocytes, phagocytes, macrophages), microbes, enzymes (proteases), destroyed and dead tissues, fats, protein fractions. It is the proteases that are responsible for the dissolution of tissues (lysis) in the lesion.

There are the following types of purulent inflammation:

• empyema - accumulation of pus in the cavity, represented by the walls of the organ;
• abscess - a cavity resulting from tissue melting, filled with purulent exudate;
• phlegmon - spilled purulent throughout the vessels, nerves, in the fascia.

One of the most common benign tumors in subcutaneous tissues - atheroma. It is formed in the places of the greatest distribution of the sebaceous glands: head, coccyx area, face, neck. Atheroma has the appearance of a rounded formation, is a cavity enclosed in a capsule, containing fat, cholesterol, skin cells.

It occurs as a result of the fact that the excretory duct of the sebaceous gland is clogged. Atheroma can be single, but in most cases there is a multiple distribution of these formations of various sizes. This tumor is painless and, in addition to cosmetic discomfort, does not cause inconvenience.

There are primary (congenital) and secondary atheromas that occur with seborrhea. On palpation, they are dense, moderately painful, have a bluish tint. Secondary tumors are localized on the face, chest, back, neck. After their opening, ulcers with undermined edges are formed.

In ambulatory surgery, atheroma inflammation is a common problem. Predisposing factors for this are the following conditions:

• insufficient hygiene;
• independent squeezing of acne, especially if antiseptic rules are not followed;
• microtrauma (scratches and cuts);
• pustular skin diseases;
• decreased local immunity;
• hormonal disorders;
• cosmetic abuse.

Festering atheroma is characterized by soreness, local redness and swelling. At large sizes, fluctuation can be noted - a feeling of fluid flow in an elastic cavity. Sometimes the formation breaks out on its own and fat-like pus is released.

Inflammation of atheroma is treated only surgically. A skin incision is made, the contents are peeled off with the obligatory removal of the capsule. When it is not completely removed, a relapse is possible after the operation. If atheroma is re-formed, inflammation can develop in the same area.

Suppuration of wounds

Wounds arise for numerous reasons: domestic, industrial, criminal, combat, after surgery. But inflammation of the wound is not always purulent. It depends on the nature and location of the damage, the condition of the tissues, age, contamination with microbes.

Factors predisposing to inflammation of the wound surface are as follows:

• wound with a contaminated object;
• non-observance of hygiene rules;
• the use of steroid hormones and / or cytostatics;
• excess body weight;
• malnutrition;
• vitamin deficiency;
• elderly age;
• decrease in local and general immunity;
• chronic skin diseases;
• severe somatic diseases;
• hot, humid weather;
• insufficient drainage of the wound after surgery.

Usually, suppuration of the wound is characterized by the accumulation of purulent inflammatory exudate in the tissue defect. At the same time, hyperemia (redness) and a “warm” edema appear around the edges, due to vasodilation. In the depth of the wound, "cold" edema predominates, associated with impaired lymphatic outflow due to vascular compression.

Against the background of these signs, bursting, pressing pain appears, and the temperature is locally elevated in the affected area. Under a layer of pus, a necrotic mass is determined. Absorbed into the blood, decay products, toxins cause symptoms of intoxication: fever, weakness, headaches, loss of appetite. Therefore, if inflammation of the wound occurs, treatment should be immediate.

Suppuration of postoperative sutures

The process of inflammation of the postoperative suture occurs, as a rule, on the 3rd-6th day after surgical procedures. This is due to the ingress of pyogenic microorganisms into the site of tissue damage. Bacteria can be brought into the wound primarily (by the subject of injury, poorly processed instruments, by the hands of medical personnel and / or the patient himself) and indirectly from the focus of chronic infection: caries, tonsillitis, sinusitis.

Predisposing factors to the development of the pathological process in the suture area:

• insufficient disinfection of medical equipment;
• non-compliance with the rules of asepsis, antisepsis;
• reduced immunity;
• poor drainage of wound discharge;
• damage to the subcutaneous tissue (hematomas, necrosis);
• low-quality suture material;
• non-compliance with hygiene by the patient;
• areas of ischemia (lack of blood supply) due to clamping of the vessel ligature.

If inflammation of the suture has developed, then symptoms such as redness and swelling of the skin around, soreness will be observed. First, serous fluid mixed with blood can separate from the suture, and then suppuration occurs.

With a pronounced process of inflammation, fever with chills, lethargy, refusal to eat appear.

A festering surgical suture should be treated only under the supervision of a physician. Incorrect independent actions can lead to the spread of infection, deepening of inflammation and the development of formidable complications up to. In this case, a rough tortuous scar is formed.

Purulent lesions of the skin and subcutaneous tissue

Pathological processes in the skin and underlying layers are very common in surgical practice. The skin and its appendages are the body's first protective barrier against various adverse effects.

Negative factors provoking the development of skin inflammation are the following:

• mechanical damage (scratches, abrasions and cuts, scratches);
• exposure to high and low temperatures (burn, frostbite);
• chemical agents (household alkalis, acids, abuse of antiseptics and detergents);
• excessive sweating and sebum secretion can cause purulent inflammation of the skin;
• poor hygiene (especially in obese people);
• diseases internal organs(pathology of the endocrine, digestive systems;
• ingrown nail.

Purulent inflammation of the skin and subcutaneous tissue can be caused by microbes introduced from the outside, and / or representatives of opportunistic flora. Suppurations of the skin are diverse in terms of localization and clinical course.

Furuncle

Suppuration and sebaceous gland - boil. It can be localized in areas of the skin where there is hair. Occurs at any age. Most common in patients diabetes and/or obesity.

Clinical manifestations are expressed in typical inflammation: hyperemia, pain, increased local temperature, swelling. Sometimes this condition is accompanied by a reaction of closely spaced lymph nodes.

Complications of furunculosis can be lymphadenitis, abscess, thrombophlebitis (inflammation of the veins), phlegmon, reactive purulent arthritis, sepsis, meningitis.

Carbuncle

Carbuncle is an acute infectious inflammation of several hair follicles with sebaceous glands. It occurs more often in adults and the elderly. Endocrine disorders play an important role in the development of this inflammation. Typical localization is the back of the neck, back, abdomen, buttocks.

At the site of infection, a dense diffuse edema occurs, the skin becomes purple and painful. There is a necrotic fusion of tissues. The carbuncle is opened in several places, creamy pus is released. The lesion with such inflammation of the skin looks like a honeycomb.

Hydradenitis

Inflammation of the sweat glands occurs mainly with uncleanliness, diaper rash, scratching. In the first place among the provoking factors is shaving the armpits. There are microtraumas of the skin, and the use of deodorant contributes to blockage of the excretory ducts of the glands.

In the area of ​​the armpit, a dense, painful tubercle is formed, the skin becomes purple-cyanotic. As the inflammation develops, the pain intensifies and interferes with movement. There is a fluctuation, the skin in the center becomes thinner, and thick pus breaks out.

With the spread of inflammation to other areas, due to the abundance of lymphatic tissue, a conglomerate of nodes with protruding papillae of the skin is formed - “bitch's udder”. If treatment is not carried out, the process can spread - an abscess or phlegmon is formed. A formidable complication of hidradenitis is sepsis.

Abscess

A cavity of a purulent-necrotic nature, limited by a capsule, is an abscess. It often occurs as a complication of inflammation, pustular diseases on the skin.

The cause of the development of a purulent cavity can be inflammation of a stab wound or injection site, when the outflow of pus is impaired.

Clinically, the abscess is manifested by edema and hyperemia of the skin in the affected area. In the depths of the tissues, a densely elastic painful formation is palpated. The skin over the abscess is hot to the touch. Symptoms of intoxication appear.

When opening an abscess and incomplete emptying or the presence of a foreign body in the cavity, the walls of the capsule do not fully close, and a fistula is formed. A breakthrough of pus can occur on the skin, into the surrounding tissues, into the cavity of the organs.

Phlegmon

A purulent-necrotic process of inflammation, located in the cellular space, without clear boundaries. The causes of phlegmon are the same as with an abscess.

In connection with the development aesthetic medicine, the formation of phlegmon can provoke corrective procedures: liposuction, the introduction of various gels. The places of localization can be any, but the areas of the abdomen, back, buttocks, and neck are more likely to become inflamed. Not uncommon - damage to the tissues of the leg.

Gradually melting the tissues, the phlegmon spreads through the fiber, fascial spaces, destroying the vessels and provoking necrosis. Often phlegmon is complicated by an abscess, hydradenitis, furuncle.

Paronychia and felon

Panaritium - inflammation of the soft tissues, bones and joints of the fingers, less often the foot. Pain with panaritium can be unbearable, deprive of sleep. At the site of inflammation - hyperemia and swelling. With the development of the process, the function of the finger is disturbed.

Depending on the localization of the lesion, panaritium can be of different types:

• skin - the formation of suppuration between the epidermis and the following layers of the skin with the formation of a "bubble";
• subungual - flow of pus under the nail plate;
• subcutaneous - purulent-necrotic process of the soft tissues of the finger;
• articular - damage to the phalangeal joint;
• tendon - suppuration of the tendon (tendovaginitis);
• bone - the transition of a purulent process to the bone, proceeding according to the type of osteomyelitis.

Paronychia - damage to the roller near the nail. maybe after a manicure, cuticle trimming. There is a throbbing pain, redness, separation of pus in this condition.

Treatment

Purulent inflammation of the soft and other tissues of the body deals with surgery. If symptoms appear that indicate a purulent lesion, it is imperative to consult a doctor. Self-treatment is fraught with the spread of the process and aggravation of the situation. The main directions of treatment:

For surgical treatment of wounds, the following methods are used:

• physical (laser radiation, plasma flows, vacuum treatment of the inflammation zone);
• chemical (various enzyme preparations: Trypsin, Chymotrypsin, Lysosorb);
• biological (removal of necrotic tissues by larvae of green flies).

At conservative therapy use the following drugs:

• antiseptics (Povidone-iodine, Miramistin, Etacridine, Chlorhexidine);
• water-soluble ointments (Dioxidin, Methyluracil);
• creams (Flamazin, Argosulfan);
• draining sorbents (collagenase);
• aerosols (Lifuzol, Nitazol).

In the period of regeneration (healing) after surgery, the following means are used:

• dressings with antibacterial ointments (Levomekol, Tetracycline, Pimafucin), stimulants (Vinilin, Actovegin, Solcoseryl);
• special wound dressings against inflammation and for healing (Vokopran);
• preparations based on natural polymers (Algipor, Kombutek).

Purulent inflammation of various parts of the body is common and has many different forms. The course of the process can be smooth or bring terrible complications leading to death. Therefore, treatment should be approached comprehensively and the full range of prescribed therapeutic measures, preventive measures to prevent the secondary occurrence of the disease should be carried out.