How does phlegmon differ from an abscess and erysipelas?
All three conditions are purulent-inflammatory, but behave differently. The abscess is limited by a dense capsule, palpated as a round formation with softening in the center and opened with a small incision. Phlegmon does not have a capsule: the inflammation permeates the tissue and spreads wider and deeper, so the boundaries of the lesion are blurred, and the operation requires wide access. Erysipelas is a streptococcal inflammation of the skin itself with a bright spot and a clear raised edge; it is treated mainly with antibiotics. It is impossible to distinguish these conditions from photographs; an examination is required.
- Abscess - pus in the capsule, there is fluctuation
- Phlegmon - pus without borders, dense diffuse infiltrate
- Erysipelas - a skin lesion with a clear ridge along the edge
- Necrotizing infection - fulminant course, extremely serious condition
- By location: subcutaneous, intermuscular, retroperitoneal, phlegmon of the neck and floor of the mouth
Causes and risk factors
The infection enters the tissue through damaged skin or from a neighboring lesion. Common ways are a contaminated wound, an animal bite, abrasion, an injection without sterility, an ingrown nail, felon, a sore tooth or an inflamed tonsil. Of particular danger are conditions in which resistance is reduced: diabetes mellitus, obesity, chronic liver and kidney diseases, taking drugs that suppress the immune system. In people with impaired lymphatic drainage and venous insufficiency, phlegmon occurs more often and is prone to relapse.
- Wounds, abrasions, bites, burns
- Non-sterile injections and manipulations
- Odontogenic source - diseased tooth
- Panaritium, ingrown toenail, boil
- Diabetes mellitus, obesity, immunodeficiency
- Lymphostasis and chronic venous insufficiency
Symptoms
The disease begins acutely. During the day, the bursting pain increases, the skin over the lesion turns red, becomes hot and shiny, the swelling is dense, without clear boundaries. Movement in the adjacent joint is limited. General symptoms quickly follow: the temperature rises to high levels, chills, weakness, headache, and loss of appetite appear. An alarming sign is a discrepancy between severe pain and relatively modest changes in the skin: this can begin a deep or necrotizing form that requires immediate surgery.
- Diffuse dense edema without clear boundaries
- Crimson hot skin
- Expanding growing pain
- High fever and chills
- Limitation of movement in a limb
- Enlarged lymph nodes, weakness, nausea
Diagnostics
The diagnosis is primarily clinical: the surgeon evaluates the boundaries of edema, tissue density, skin color and general condition. Ultrasound examination of soft tissues helps to distinguish diffuse inflammation from a formed abscess and find accumulations of fluid. A general blood test shows severe inflammation, and glucose and kidney function are also assessed. The pus obtained during the operation is sent for culture to determine sensitivity. In case of deep location, phlegmon of the neck or retroperitoneal space, computed tomography is performed.
- Examination by a surgeon
- Ultrasound of soft tissues
- General blood test and biochemistry
- Blood glucose
- Culture of pus with antibiogram
- CT or MRI for deep localization
Treatment
The basis of treatment is surgery. The surgeon widely opens the affected area, removes pus and non-viable tissue, washes the wound and leaves drains so that the discharge can come out freely. The wound is kept open, with regular dressings, and stitches are applied later when the inflammation subsides. At the same time, broad-spectrum antibiotics are prescribed, which are then adjusted based on culture results, pain relief and, in severe cases, intravenous infusions. Attempts to treat phlegmon with ointments, compresses and heating are dangerous: they only delay the operation and contribute to the spread of pus.
- Urgent opening and drainage
- Removal of non-viable tissue
- Dressing a purulent wound
- Antibiotics intravenously with subsequent correction
- Infusion therapy and pain management
- Monitoring blood sugar and treating underlying disease
