Ask for help on how to treat purulent dactylitis

Anti-inflammatory, is there suppuration, if there is, the pus must be removed.

When pain occurs in the fingertips and the swelling is not obvious on examination, hot salt water can be soaked several times for about 20 minutes each time; Topical application of medication may also be used (see paronychia**). Use sulfonamides or antibiotics as appropriate. Inflammation usually resolves with these treatments.

If there is a jump mark and the tension of the finger increases significantly, it should be incised to reduce pressure and drainage, and it is not possible to wait for the fluctuation to appear before surgery. Although there is little or no pus after incision, it reduces the pressure in the closed cavity of the finger, reducing pain and complications. During surgery, a longitudinal incision is made on the side of the affected finger as long as possible, but not beyond the junction of the distal and median segments to avoid injury to the tendon sheath (Figs. 11-4).

During the incision, the fibrous septum in the subcutaneous tissue is cut forcefully, and the adipose tissue protruding from the incision is cut so as not to affect drainage. If the abscess cavity is large, it can be drained with the mouth, but a fish-shaped incision should not be made, so as not to affect the infection of the affected finger after postoperative scarring. Latex sheets are placed inside the incision for drainage.

When incision and drainage, if there are pieces of dead bones, they should be removed. After the operation, the whole body is treated as a general suppurative infection. Another method is to make a straight incision on the palmar surface of the distal part of the finger, drain the pus without draining, and apply a thick layer of zinc oxide ointment, bandage it, and replace it every 2 to 3 days until it heals.

This type of incision is superior to the side incision, and the drainage is direct and unobstructed; The damage of cellulose and fat pad is small, which does not affect the function of postoperative sluggers, and the complication of ipsilateral finger loss of sensation caused by non-lateral incision is easy to damage the finger nerve; The scar is not painful.

In purulent dactylitis, it is best to do a bacterial culture of pus, and choose sensitive drugs**, which have a good effect. In addition, in addition to local dressing changes**, infrared irradiation can also be used to irradiate the local area, which also has anti-inflammatory and bactericidal effects.

Analysis:

Hello, it generally takes about half a month to be able to **.

Guidance: It is recommended that you infusion anti-inflammatory after surgery, plus oral metronidazole tablets and amoxicillin capsules, etc., change the dressing once a day, I wish you health!

Purulent dactylitis is a subcutaneous suppurative stain that occurs at the distal part of the fingers. Because of the infection, the whole finger abdomen is highly swollen and resembles a snake's head, so it is called "snake head boil" or "scrofula" because the subcutaneous tissues of the finger abdomen are arranged very closely, so at the beginning of the infection, the tissue is very swollen, and the intracavity tension is significantly increased, the pain is severe, and the blood supply of the distal phalanx is obstructed. In the early stages of the disease, local symptoms are severe; The fluctuating sensation of the infected area is difficult to detect after abscess formation and is an important feature of the disease.

**] Forearm flat and immobilized to reduce swelling and pain.

In the early stage, warm compresses, potassium permanganate soaking, and 3% iodine tincture can be applied, and active anti-infection** can make the inflammation subside. Before an abscess forms, the affected finger can be applied with a Ruyi Golden Loose compress.

Incision and drainage as soon as possible, because it is difficult to detect fluctuating sensation in the infected area, so according to the time of infection, incision and drainage can be performed when throbbing pain occurs or affects sleep, and it cannot wait. Even if there is not a lot of pus after the incision, it is beneficial to relieve symptoms and control the spread of inflammation.

Under the anesthesia of digital nerve block, a longitudinal incorpum is made on the lateral side of the distal fingers, the distal end of the incision does not exceed the nail groove 1 2, and the proximal end does not exceed the transverse strip of the knuckles. Intraoperative necrotic tissue is removed and the infected fibrous septum is completely opened, but the deep periosteum and sheath should be protected to prevent the spread of inflammation. Latex sheet is inserted for drainage.

Intraoperative drainage should be avoided on both sides, let alone a fish-mouth drainage incision at the finger end. The former often leaves a large scar under the abdomen, which makes the pain sensitive when holding and pinching objects, and affects the function. In the latter, due to the retraction of the scar, the healthy search of the finger tip is uneven, affecting the function and appearance.

Antibiotics**, intramuscular injection of penicillins is preferred, and cephalosporins are recommended for patients with allergies.

(1) The cause of the disease.

Purulent dactylitis is usually caused by a fingertip foreign body puncture and can also be secondary to paronychia. The main pathogen is Staphylococcus aureus.

ii) Pathogenesis.

There are many longitudinal fibrous cords between the volar surface of the distal finger and the periosteum of the phalangeum, which divide the soft tissue into many closed small cavities, which contain adipose tissue and a rich network of nerve endings. In the event of infection, pus does not spread easily to the surrounding area, so the swelling is not significant. However, the pressure in the abscess cavity is very high, which can not only cause very severe pain, but also compress the trophic blood vessels of the distal phalanx, causing ischemia and necrosis of the phalanges.

In addition, direct invasion of pus into the phalanges can also cause osteomyelitis.

** of purulent dactylitis

1 In the early stage, when there is only finger pain and the pain is mild, and there is no obvious swelling, hot water soaking, hot compress, physiotherapy, elevation of the affected limb, external application of traditional Chinese medicine Zhengduan and antibiotics can be used, and the inflammation can subside in about half of the patients.

2 If there is severe pain at the finger end, the swelling is obvious, and the tension of the finger abdomen is increased by palpation of the stool, incision and drainage should be performed to relieve the high pressure in the abdominal space of the fingers, reduce the pain, and prevent bone destruction and osteomyelitis from forming a rough reputation.

Local pain is the main symptom. It is usually stabbing at first, and as the local inflammation increases, the pressure in the finger-abdominal space increases, and the local severe pain occurs. When the digital arteries on both sides of the finger are compressed, throbbing pain may occur.

When the hand is lowered or the fingers are tapped, the pain is more intense due to the increased pressure, and the patient is often unable to sleep at night due to severe pain. There may be redness and swelling at the fingertips, but it is often inconspicuous; As the pressure in the subcutaneous space of the finger belly increases, blood circulation is impaired, and the finger tips may appear yellowish-white. If left untreated, chronic osteomyelitis can develop.

In purulent dactylitis, there are often symptoms of different degrees of systemic infection and poisoning, such as fever, fatigue, loss of appetite and other symptoms, and the white blood cell count may be elevated in routine blood tests.

1.The distal joints of the fingers are often swollen and snake-headed in appearance, accompanied by severe throbbing pain, which is worse when the hand hangs. ,2.

The volar side ** tension is large, reddish and obviously tender, and the local fluctuation sensation is not obvious. ,3.If the treatment is not timely, it can break up on its own, the wound will not heal for a long time, and X-ray can show necrosis of the distal phalanges.

4.It may be accompanied by systemic symptoms such as fever and headache. , 1) the distal mediastinum of the distal finger segment, showing a closed small cavity of the subcutaneous tissue, (2) Schematic diagram of the surgical incision for purulent dactydactyly, Figure 1

Purulent dactylitis.