purulent diseases of fingers -...
TRANSCRIPT
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General surgery department of SGMUass. Khilgiyaev R.H
PURULENT DISEASES OF FINGERS
general surgerydepartment
Training program
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General surgery department of SGMUass. Khilgiyaev R.H
Felon is
Furuncle version
Purulent inflammation of hand fingers
Purulent inflammation of any finger
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General surgery department of SGMUass. Khilgiyaev R.H
Certainly not
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General surgery department of SGMUass. Khilgiyaev R.H
Historically the term of “felon" isapplied only to purulent diseasesof hand fingers
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General surgery department of SGMUass. Khilgiyaev R.H
Felon is an acute suppurativedisease of fingers
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General surgery department of SGMUass. Khilgiyaev R.H
Main cause of Felon development
immunity deficiency
Microinjury of a finger
Gematogenes infection spreading
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General surgery department of SGMUass. Khilgiyaev R.H
Theoretically probably, but it is almost improbable
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General surgery department of SGMUass. Khilgiyaev R.H
wrong
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General surgery department of SGMUass. Khilgiyaev R.H
Correctly!
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Felon
osteal
tendinous
articular
pandactilitis
The superficial The deep
cutaneous
paronychial
hyponychial
subcutaneous
furuncle of thefinger
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General surgery department of SGMUass. Khilgiyaev R.H
The disease has begun after one has rubbed finger skin with a
glove at a physical activity. There was a blister with muddy
contents. Skin around a blister is hyperemic. Diagnosis?
•Bedsore of finger skin
•The infected callosity of a finger
•cutaneous felon
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General surgery department of SGMUass. Khilgiyaev R.H
Bedsore appears at a long pressure of amotionless site of a body – a sacrum, anape, interscapular area
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General surgery department of SGMUass. Khilgiyaev R.H
The term «the infected callosity» sometimes is applied, but mainly in relation to diseases of feet
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General surgery department of SGMUass. Khilgiyaev R.H
Correctly!
cutaneous felon- a local pus accumulation within skin (asite under epidermis). Often felon is accompanied with expressed lymphangitis and lymphadenitis.
Treatment surgical - is made removal of epidermis, as arule thus it is not required anaesthesia. Purulent exudateis evacuated, then it is necessary to examine carefully ansurface not to pass felon in the form of "cuff link" (whenpurulent process by a narrow fistula extends insubcutaneous tissue). The inflammatory is stopped within5-10 days depending on spreading of process.
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General surgery department of SGMUass. Khilgiyaev R.H
Soon after performance of manicure there was a pain at the
basis of a nail plate. Skin is red. Diagnosis?
Abscess of the nail
erysipelas
Paronichial
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General surgery department of SGMUass. Khilgiyaev R.H
Erysipelas of a finger happens. Its feature isdistinct margins and a bright redness of skin. Sometimes (after pork cutting) on a finger thereis «a pork Erysipelas» - Erysipeloid. But on thisphoto is not an Erysipelas
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General surgery department of SGMUass. Khilgiyaev R.HCorrectly!
paronychial- an inflammation of the nail fold.
wrong treatment the paronychial can get a chroniccurrent, delivering a great deal of trouble to the patient.
reason, as a rule, agnail , or wound of skin at manicure. There is a edema, redness of the nail fold, intensivepains. Pus can spread to beneath the nail plate dividing it from the sides
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General surgery department of SGMUass. Khilgiyaev R.H
At a paronychial it is necessary cut epidermis and pathological
granulations; to raise the nail fold and to wash the inflammation
place. Usually the regional resection of a nail plate is required
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General surgery department of SGMUass. Khilgiyaev R.H
After casual blow a hammer on a finger pain disturbed under a nail plate.
Under a nail plate there was dark, almost black spot. Then pain has
become stronger, the nail plate exfoliated – brown pus with a blood clot
was disharged. Diagnosis?
Hemorrhagic gangrene of anail phalanx
Hyponychial
Pururelent hematoma
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General surgery department of SGMUass. Khilgiyaev R.H
Such does not happen
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General surgery department of SGMUass. Khilgiyaev R.H
Correctly!
Hyponychial- a purulent inflammation under a nail plate, thus the nail plate exfoliates from a nail bed on a bigger orsmaller extent. The disease can be as a result of aparonychial; at direct introduction of an infection under anail plate (a prick a needle, a nail); or is complication of ahematoma under nail(often after an injury of a finger by thedoor).
Disease prevention - competent treatment of a paronychial and early evacuation of hematoma after a trauma.
At the limited local exfoliation of a nail plate pus (less than1/3 its total areas) is admissible to execute a nail resectiononly on the changed site. In case of more extensive lesion itis necessary to delete completely a nail plate, keeping agrowth zone of a nail (if it is possible). Usually erozivsurface of a nail bed is epitelized on the average in 10-15 days after operation.
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General surgery department of SGMUass. Khilgiyaev R.H
Choose a combination of a paronychial with
Hyponychial
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General surgery department of SGMUass. Khilgiyaev R.H
NO
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General surgery department of SGMUass. Khilgiyaev R.H
Correctly!
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General surgery department of SGMUass. Khilgiyaev R.H
In the anamnesis microtrauma. On a surface of a
finger there is a blister filled with muddy liquid. Around
– a soft redness. Define the diagnosis
Intracutaneousfelon
Paronychial
erysipelas
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General surgery department of SGMUass. Khilgiyaev R.H
Subcutaneous felon– abscess
of subcutaneous tissue of hand
finger
Correctly!
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General surgery department of SGMUass. Khilgiyaev R.H
Subcutaneous felon
The disease develops at direct introduction ofan infection in subcutaneous tissue of a fingerwith further development of a purulentinflammation. As a rule is a consequence of amicrotrauma - a prick, a cut, a splinter etc. Atfirst moderate edema and redness of skin of afinger, further the inflammatory process isnoted progress, pains gain pulsing character, become very intensive. Treatment surgical.
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General surgery department of SGMUass. Khilgiyaev R.H
Yesterday has pricked a finger when cutting fish. Constant moderate pain
in a prick place disturbs. Round a prick place a morbidity zone with a soft
redness without tension of soft tissues. Tactics:
Immediately to operate
To prescribe antibiotics
To paint skin around a woundiodine tincture, to apply alocal hypothermia
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General surgery department of SGMUass. Khilgiyaev R.H
Term of development of apurulent disease – 2-3 days. Convincing signs of an abcess itis not described
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General surgery department of SGMUass. Khilgiyaev R.H
Antibiotics at anything. To create effectiveconcentration of antibiotics in the inflammation
place all the same it will not be possible
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General surgery department of SGMUass. Khilgiyaev R.H
In a phase of a serous exudation anti-inflammatory
therapy is applied.
If there is a trace of a stabwound, it is necessary to
cut off hanging epidermis and to apply cold and
rest. Cooling of a finger repeats 5-6 times. Then
the sterile bandage and an immobilisation is
applied. Krioterapiya not unique method, but
available and effective method of treatment.
Correctly!
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General surgery department of SGMUass. Khilgiyaev R.H
Surgical treatment is shown at development of a purulent inflammation.
Thus pains are get pulsing character, there is a area of a redness and
tension of tissues.
On a nail phalanx of a finger the " hockey stick " cut is made, on middle and main phalanxes the cuton a lateral surface is made. Skin and hypodermicrags are parted and necrotic tissue is removed
the formed cavity is carried out by a gauze stripwith levomekol. Further, daily change of bandagesis made.
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General surgery department of SGMUass. Khilgiyaev R.HChoose a type of anaesthesia for opening
Subcutaneous felonof an middle phalanx III finger of
the right hand
Intravenous anaesthesia
Terminal anaesthesia with chloretyl
Conductive anaesthesia according toLukashevich-Oberst
Conductive anaesthesia according toKullenkampf
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General surgery department of SGMUass. Khilgiyaev R.H
It is absolutely impractical …
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General surgery department of SGMUass. Khilgiyaev R.H
It is painful!
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General surgery department of SGMUass. Khilgiyaev R.H
Conductive anaesthesia accordingto Kullenkampf is an anaesthesiaof a humeral plexus
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General surgery department of SGMUass. Khilgiyaev R.H
Operation is carried out under
Conductive anaesthesia according
to Lukashevich-Oberst
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General surgery department of SGMUass. Khilgiyaev R.H
Cuts in Subcutaneous felon
Cuts on lateralsurfaces of fingers
" hockey stick " cutson a distal phalanx
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General surgery department of SGMUass. Khilgiyaev R.H
Choose an optimum surgical cut at treatment of felon
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General surgery department of SGMUass. Khilgiyaev R.H
Opening Subcutaneous felon
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General surgery department of SGMUass. Khilgiyaev R.H
Optimum surgical treatment of a paronychial
Removal of a nail
plateCut along edge of
the nail fold
excisionof edge of the nail
fold and regional resection
of a nail plate
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General surgery department of SGMUass. Khilgiyaev R.H
How to drain a wound after opening a felon?
Gauze napkin with ointment Vishnevsky
Rubber strip
It is not necessary to drain. It isnecessary to place suture
Correctly!
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General surgery department of SGMUass. Khilgiyaev R.H
It is impossible so to act
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General surgery department of SGMUass. Khilgiyaev R.H
Opening felon
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General surgery department of SGMUass. Khilgiyaev R.HChoose felon on the cuff link type
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General surgery department of SGMUass. Khilgiyaev R.H
Correctly!
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General surgery department of SGMUass. Khilgiyaev R.H
After a microinjury of a nail phalanx of a finger there was not healing
wound with the purulent secretion. For medical care has addressed in two
months from the disease beginning. In a hospital long treatment was
carried out. Define character of a disease
Purulent fistula ofa finger
It is long nothealing felon
Osteal panaritium(Bone felon )
sequestrum
Before treatment
After treatment
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General surgery department of SGMUass. Khilgiyaev R.H
Bone felon is osteomyelitis of a bone phalanx of a
finger.
Develops upon transition of pathological process
from soft tissues of a finger to bone, i.e. process has
secondary character.
Generally bone panaritium is the result of not
appropriate treatment of.
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General surgery department of SGMUass. Khilgiyaev R.H
Microinjury of a finger a week
ago – has pricked a finger with a
wire.
In a x-ray picture rough
pathology is not present.
Define treatment tactics
•Plaster immobilisation, cold, antibiotics
•Operation – an excision edges of a wound, opening a
panaritium
•Thermal procedures, control of a x-ray picture
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General surgery department of SGMUass. Khilgiyaev R.H
The result of your treatment will be such
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General surgery department of SGMUass. Khilgiyaev R.H
Operation should be carried out
without waiting the obvious
destructive changes defined
radiological.
It is necessary to be guided by a
clinical picture of a course of process.
Diagnostic bone panaritium in 3-4
weeks in a phase of a sequestrum
comes easy, but treatment will consist
in finger amputation.
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General surgery department of SGMUass. Khilgiyaev R.H
Has ached 2 weeks ago. The disease connects with a microtrauma. There
was a redness in a joint. Disturbs pain at the straightened finger. Finger is
bended. Diagnosis?
Bursitis of
interphalanx joint
Erizepeloid
Articular panaritium
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serous -purulent inflammation ofinterphalanx and metacarpal-phalanxjoints of fingers is called articular panaritium
Primary articular panaritium– woundsgetting into a joint, pricks
The secondary – progressing bone, tendon, subcutaneous panaritium
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General surgery department of SGMUass. Khilgiyaev R.H
Articular panaritium
fusiform distension of a finger inprojections of an interphalanxjoint,
sharp restriction of movements ina joint,
tendiness at a palpation and atmovements,
appearance of pathologicalmobility and a krepitation in ajoint.
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General surgery department of SGMUass. Khilgiyaev R.H
Trauma 5 days ago.There is a purulent wound of the back of a finger. In
policlinic local treatment by bandagings with oil was carried out. Your
tactics:
Hospitalisation inpurulent department of ahospital
Treatment in policlinic toadd with prescription ofantibiotics
Immediately to operate
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General surgery department of SGMUass. Khilgiyaev R.H
What to operate?
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General surgery department of SGMUass. Khilgiyaev R.H
Here result of such treatment
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General surgery department of SGMUass. Khilgiyaev R.H
The patient will be dissatisfied. The insurance company can
be dissatisfied. Operations can be demanded. But the patient
will be under control of surgeons
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General surgery department of SGMUass. Khilgiyaev R.HWhether it is possible to keep a
finger at this articular
panaritium?
The finger should be amputated
It is necessary to apply a plaster
immobilisation, to order
antibiotics, a joint puncture
with washing its by antiseptics
It is necessary to perform an
arthrotomy with excision of
articulate cartilages
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General surgery department of SGMUass. Khilgiyaev R.H
While early
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General surgery department of SGMUass. Khilgiyaev R.H
Yes. It is necessary to
try to keep a finger
Treatment only surgical - is made an
arthrotomy, careful sanitation of a
cavity of a joint by antiseptics then the
cavity of a joint is drained by the
punched polymeric tube. It is necessary
to close a wound over a joint cavity.
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General surgery department of SGMUass. Khilgiyaev R.H
In what case finger amputation is shown?
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General surgery department of SGMUass. Khilgiyaev R.H
In two last cases amputation is shown
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General surgery department of SGMUass. Khilgiyaev R.H
Tendinouspanaritium
one of the heaviest types panaritium. Thereis signs of purulent tendovaginitis. Thedisease develops due to primary entering ofan infection into a tendon sheath offlexor(at a cut, a prick etc.), or asprogressing of hypodermic process atinadequate treatment of the last. Development of a purulent infection intendon sheath has bright clinical picture -the patient is disturbed by the expressedpains along the whole length of tendon, any movements are extremely painful. Thesurgical help should be performed as soonas possible as tendons quickly die in theconditions of surrounding purulent process.
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Tendinous panaritium
Uniform swelling of all finger with edemaon a back surface of a hand;
tenderness at pressure by a probe along the whole length of tendon sheath , precisely limited by a zone of its location;
Sharp pain at movements, especially at astraightening;
Finger fixing in the position of easybending.
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General surgery department of SGMUass. Khilgiyaev R.HTendinous
panaritium
At development of a purulent
infection in a tendon sheath the
expressed pain along the whole
length of tendon sheath disturbs,
any movements are extremely
painful.
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General surgery department of SGMUass. Khilgiyaev R.HTendinous
panaritium
The surgical helpshould be performed as soon as possibleas tendons quicklydie in the conditionsof surroundingpurulent process
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General surgery department of SGMUass. Khilgiyaev R.H
Tendinous panaritium
Operation is made underconductive anaesthesia or undernarcosis. The main task ofoperation – to open a tendon sheath and to estimate viabilityof a tendon. If it is viable, thesheath is carefully washed outby antiseptics from two partiesand is drains by the punchedpolymeric tubu.
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General surgery department of SGMUass. Khilgiyaev R.H
At identification of a necrosis of
tendon the last is cut within healthy
tissues. Operation is ended with wound
filling by a gauze strip with levomekol.
Further, secondary sutures are placed.
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General surgery department of SGMUass. Khilgiyaev R.H
Opening of a sheath releases a fingertendon from pressure and prevent necrosis
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General surgery department of SGMUass. Khilgiyaev R.HOpening Tendinous
panaritium
it is important to open end of the
sheath at level of a head of a
metacarpal bone. For this purpose
use a " hockey stick " cut below
the finger basis
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General surgery department of SGMUass. Khilgiyaev R.H
Whether it iscorrectly openedTendinouspanaritium?
Yes. Some cuts are executed.
The abscess is adequately
drained.
No. Viability of a finger in
doubt
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General surgery department of SGMUass. Khilgiyaev R.H
Part of surgeons open Tendinous panaritium
exactly so. But …
On a photo it is visible that soft tissues of a finger are
inflamed on all its extent. It means that the necrosis
of a tendon has taken place. It is impossible to
remove a tendon from a set of small cuts. It will
continue to support pyoinflammatory process before
development pandactilitis.
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General surgery department of SGMUass. Khilgiyaev R.H
tendon sheaths II-IV fingers endat level of heads of metacarpal bones.
sheaths I and V fingers proceedon a forearm via the karpalchannel
Therefore progressing of purulenttendovaginitis I and V fingersleads to development ofphlegmon of Pirogovsky space ofa forearm
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General surgery department of SGMUass. Khilgiyaev R.H
inTendinous panaritium I and V fingers
opening deep space of a forearm is necessary
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General surgery department of SGMUass. Khilgiyaev R.H
pandactilitis is
Inflammation of all fingers
It is purulent - necrotic lesions of allstructures of a finger
Finger gangrene
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General surgery department of SGMUass. Khilgiyaev R.H
pandactilitis is nonspecific purulent - necrotic
lesions of a finger extending not less than on
two phalanxes and affecting skin,
subcutaneous tissue, tendon, a bone or at least
one of joints. Pandactilitis is not gangrene.
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General surgery department of SGMUass. Khilgiyaev R.H
In what photo it is represented
Pandactilitis ?
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General surgery department of SGMUass. Khilgiyaev R.H
No. It is a necrosis of fingers aftertheir unsuccessful transplantation
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General surgery department of SGMUass. Khilgiyaev R.H
Correctly. Itself Pandactilitis yet is not the indication
to finger amputation, but its probability is high