Features of the manifestation of phlegmon, methods of its treatment and prevention. Treatment of phlegmon of the leg: is it necessary to suture after removal Odontogenic phlegmon ICD 10

Representing an extensive lesion of living subcutaneous tissue without clearly defined boundaries, phlegmon can affect various parts of the human body. Its manifestations are quite characteristic, but the existing similarities with make it necessary to conduct a preliminary diagnosis in order to make the most accurate diagnosis. And since the chosen treatment method in most cases depends on diagnosis, subjective manifestations and examination data provide the most complete information for the attending physician.

Cellulitis, which occurs for several of the most common reasons, can be localized in different parts of the body, but its manifestations are similar and cause serious discomfort for a person. Like any other skin lesion, phlegmon is cured faster if it is detected at the earliest possible stages. Therefore, even with the initial manifestations of damage to the subcutaneous tissue, you should contact a dermatologist for an examination.

Features of the disease

Manifesting itself in the form of damage to living tissue located directly under the skin, phlegmon can occur in both the female half of the population and the male half. According to age indicators, this lesion can occur at almost any age. However, it is most often diagnosed in middle age, mainly from 35 to 55 years (these are medical statistics).

There are no fundamental differences in the course of this purulent process in men and women.

• In childhood Typically, phlegmon can appear in a place that has been subjected to trauma or mechanical stress.
• In adults phlegmon can form not only at the site of mechanical damage, but also against the background of the current inflammatory process, as well as after its treatment. Abscesses and purulent wounds are the most common manifestations accompanying phlegmon, which significantly influence and even provoke its formation.

ICD 10 code: L03 Phlegmon.

Localization

The area where phlegmon occurs may vary. However, as practice shows, the following parts of the body are most often affected by this type of purulent lesion of fatty tissue (phlegmon):

• breast;
• hips;
• buttocks;
• back (especially its lower part);
• sometimes - the face and neck area.

Since the main reason for the appearance of phlegmon should be considered the penetration of pathogenic microorganisms into the tissues of adipose tissue, breaks and cracks in the skin, these places require special attention in case of any mechanical damage.

Phlegmon of the lacrimal sac (photo)

Classification

Today, the generally accepted classification of such a purulent process is its division by location. And since, depending on the location of the phlegmon, it can have slightly different symptoms, when conducting diagnostics, it is necessary to determine whether the developing pathological process belongs to a certain type.

By location

So, depending on the location of phlegmon, it is divided into the following types:

1. Subcutaneous, which progresses directly in the layer of subcutaneous fat.
2. Subfascial.
3. Retroperitoneal(phlegmon of the retroperitoneal space), detected by conducting a general examination of the abdominal cavity with frequent complaints of the patient about pain in the abdomen.
4. Intermuscular, which is usually accompanied by ongoing or progressive inflammatory processes in the muscle layer.
5. Perinephric, accompanied or caused by kidney diseases - this is how pathogenic microflora penetrates into this area.
6. Pararectal, located near the rectum and its origin is due to the penetration of pathogenic microorganisms through the walls of the rectum. The most common cause of phlegmon in this case is long-term constipation and intestinal instability.

Since the formation of phlegmon may not be directly related to mechanical damage to the skin and the infection is introduced into the subcutaneous tissue through the hematogenous route during relapses and long-term diseases, sometimes determining the exact membership of a specific group of phlegmon is not possible.

A specialist will tell you about phlegmon in detail in the video below:

Process stages

Cellulitis can also be classified depending on what stage of the process the disease is at. So, doctors highlight:

• chronic and acute course of the disease,
• superficial location of phlegmon or its location in deep layers of fatty tissue,
• its distribution is limited or widespread.

Causes

Typically, according to medical data, the cause of the occurrence and further progression of phlegmon is considered to be mechanical damage to the skin. And through wounds and cracks in the skin, pathogenic microorganisms quickly penetrate, provoking a purulent process in the fatty tissue.

The reason for the onset of any purulent process is the activation of pathogenic bacteria in the wound surface. Their penetration can occur not only due to ruptures and injuries of the skin, but also by spreading through the circulatory and lymphatic systems. Also, reasons that can stimulate the formation of phlegmon include:

• penetration of Staphylococcus aureus fiber into tissues;
• streptococcus;
• hemophilus influenzae infection, which is most often activated in children. Its penetration can occur through dog bites;
• anaerobes (bacteroides, peptococci, clastridia);
• diphtheria bacillus.

The listed microorganisms and bacteria, when they enter fatty tissue against the background of a general weakening of the human body, are able to begin active reproduction, which causes the onset of a purulent process called phlegmon.

Symptoms

Characteristic symptoms of any purulent process can be called the occurrence, pain, which increases with the progression of the disease, and the spread of the purulent process to adjacent healthy tissues in the absence of the necessary therapeutic effect.

The most obvious manifestations of phlegmon include the following:

• soreness of the affected area, which increases depending on the stage of the current pathological process;
• redness of the affected area;
• rapid spread of phlegmon during an acute process with an increase in the number of affected tissues;
• pain can manifest itself not only when palpating the affected area, but also when turning the body.

The area of ​​tissue damage during the development of phlegmon does not have clearly defined boundaries, but the surface of the skin here becomes more shiny and glossy. Common manifestations in the initial stages of the disease include the appearance, deterioration of general condition, decreased duration and quality of night sleep; in later stages of the pathological process, shortness of breath and yellowing of the skin may be observed.

Diagnosis and treatment of cellulitis in newborns, children and adults are described below.

Diagnosis of phlegmon

Methods for diagnosing the current putrefactive process when identifying phlegmon may vary, but first of all these will be the subjective sensations of the patient.

Diagnostic measures for the development of phlegmon include:

• visual examination of the patient,
• measuring his body temperature (as the development of phlegmon intensifies, the temperature rises),
• Ultrasound is also used for internal location of phlegmon.

Diagnosis is carried out under the condition of hospitalization of the patient, since this disease is dangerous not only for health, but in advanced stages - also for life.

Opening and treatment of phlegmon of the orbit, lower jaw, legs, arms (limbs), legs, mouth - we will consider all this below.

Treatment

Today, the therapeutic effect when identifying phlegmon can be carried out therapeutically or medicinally, as well as through surgical intervention. The operation can be used in cases where there is an infiltrate in the affected area: during surgery, the tissue is cleansed and the infiltrate is removed.

Therapeutic

For treatment in the initial stages, hospitalization of the patient is not required.

• If there is no infiltration in the affected area, the doctor usually prescribes local heat in the form of heating pads and warming compresses.
• A set of UHF procedures may also be recommended.
• Antibacterial therapy may also be prescribed, which stops the activity of the reproduction process of pathogenic microflora.

The opening of the submandibular phlegmon is shown in this video:

Medication

When phlegmon is detected, drug treatment should be considered the use of complex therapy with broad-spectrum antibacterial drugs to stop the purulent process in the tissues. Also, medications can be used after surgery, while the direction of action of the drugs is to quickly heal the wound surface and stop the inflammation process.

The medications most often used in the treatment of phlegmon include drugs from the penicillin group, as well as agents that stimulate the rejection of necrotic tissue: Iruksol, Terrylitin, Trypsin.

Operation

Surgical intervention is the most effective method of treatment for advanced stage phlegmon, when the affected tissues have purulent exudate, which should be removed during surgery.

To perform the operation, the patient is given full anesthesia, which allows for complete cleansing of phlegmon not only from the affected tissues, but also from the adjacent soft tissues to prevent possible relapses after surgery.

Abscesses and phlegmons of the maxillofacial area

Disease prevention

As a preventive measure, the use of drugs that enhance immunity can be used, since it is precisely when the functioning of the immune system is unbalanced that there is an activation of all inflammatory processes in the body and its reduced ability to resist.

Also, in case of any mechanical damage, skin wounds should be treated with disinfectant solutions with the utmost care to avoid infection. And for any manifestations of discomfort after suffering a mechanical injury or a long-term inflammatory process in the body, undergo a medical examination.

Complications

When phlegmon is detected, side effects are likely to occur, especially in advanced stages with the formation of a significant amount of infiltrate. Complications of phlegmon include a high probability of deepening the current inflammatory process into neighboring tissues, which increases the risk of general infection of the body.

When determining likely complications when diagnosing phlegmon, its location should be taken into account.

• Thus, when phlegmon forms in the neck area, advanced stages are fraught with suffocation due to an increase in the volume of affected tissues.
• When phlegmon forms in the head area, infection can penetrate into the brain, which can cause damage and inflammation.

Forecast

With the rapid identification of phlegmon in any location, the patient's survival rate is usually 100%. However, in advanced stages, as well as in case of insufficient treatment, survival rate decreases and sometimes there may be an increased risk of death.

Commissural phlegmon is also operable, as the video below will tell you:

What is phlegmon?

Phlegmon is an acute purulent inflammatory process that occurs in fatty tissue and spreads to surrounding tissues, including tendons and muscles.

The disease occurs at any age, equally often in men and women. The inflammatory process can develop on its own or is a complication of other purulent processes - carbuncles, boils, abscesses and others.

Where does phlegmon occur?

Inflammation of fatty tissue can occur as a result of a violation of the integrity of the skin when pathogenic microorganisms penetrate the wound.

However, as practice shows, the disease most often develops where there were no injuries or damage. Favorite places for localization of the pathological process are:

1. Breast;
2. Anterior abdominal wall;
3. Back;
4. Hips;
5. Buttocks.

Cellulitis of the face and neck is quite common.

When the skin is damaged, the cause of an acute inflammatory process is obvious - the penetration of bacteria from the outside. When phlegmon forms “out of the blue,” its exact causes have not been established by medical science.

However, it is believed that chronic foci of infections in the body or weak immunity can cause the development of the inflammatory process.

Predisposing factors are:

• Diabetes mellitus or other disorders of the endocrine system;
• Exhaustion of the body, for example, in cancer patients;
• Taking medications that have a detrimental effect on the immune system;
• Immunodeficiency conditions;
• Severe intoxication of the body.

Forms of the disease

There are several forms of the disease:

Serous phlegmon – inflammation is caused by the accumulation of pathological exudate (fluid). The fiber becomes cloudy in appearance as a result of being saturated with accumulated liquid.

The boundaries of the pathological focus and non-infected tissues are practically invisible.

Purulent phlegmon – the tissue surrounding the pathological focus begins to melt, resulting in the formation of a large amount of pus. With this form of the inflammatory process, fistulas or ulcers often form near the lesion, from which a green-yellow liquid is released.

As phlegmon progresses, the disease spreads to the muscles and fascia, as a result of which the tissues acquire a gray coating and become saturated with pus.

Putrid – at this stage, the tissue structure is destroyed and gases are formed, as a result the neoplasm emits an unpleasant smell of rot.

The location of the pathological process and the tissues located nearby acquire a mushy, dark-colored shape. This condition leads to severe intoxication of the entire body.

Necrotic form – necrotic foci (dead skin) form on the surface of the neoplasm, which are subsequently rejected by the body, and bleeding wound surfaces remain in their place.

Often, after necrotic phlegmon, abscesses form, the treatment of which is carried out (mainly) surgically.

Anaerobic – the inflammatory process spreads to large areas of fatty tissue, causing the formation of necrotic foci with the release of gas. Affected tissues acquire an earthy tint and an unbearable unpleasant odor.

When palpated, a crunching sound (crepitation) is clearly audible, which is caused by the accumulation of gases. The tissue around anaerobic cellulitis resembles boiled meat.

Symptoms of phlegmon, photo

The clinical picture of the disease is acute. At the initial stage, the site of localization of the inflammatory process is sharply painful, hot to the touch, and swollen. Softened areas of the tumor indicate accumulation of pus under the skin.

As the disease progresses, general symptoms also appear:

• Increased body temperature (up to 39.0-40.0 degrees);
• Fever;
• Increasing weakness;
• Increased thirst (often with phlegmon, patients complain of severe dry mouth);
• Shortness of breath, increased heart rate;
• Severe headaches
• Pale skin and decreased blood pressure.

Against the background of general intoxication of the body, the patient may experience vomiting, anuria (or oliguria), and a weak thread-like pulse.

Treatment of phlegmon

When diagnosing phlegmon, hospitalization in the surgery department is required. In the acute period, strict bed rest is indicated. If pus has accumulated at the site of infiltration, it should be immediately removed by surgical opening and drainage.

If the disease is detected at the stage of infiltration formation, that is, before tissue softening and pus accumulation, treatment of the inflammatory process is carried out by conservative methods - the use of thermal procedures, ultraviolet radiation, mercury ointment.

When a compaction has formed and the body temperature is high, the patient is prescribed a phlegmon operation in order to ensure a high-quality outflow of pus.

After the pus drains, the cavity is washed and special tubes are inserted. A sterile gauze bandage moistened with a 10% sodium chloride solution is applied to the wound.

Patients with acute inflammation of adipose tissue are required to be prescribed broad-spectrum antibiotics, as well as general health-improving drugs and vitamins.

To eliminate pain, it is advisable to prescribe analgesics, and to relieve fever - antipyretic drugs.

To speed up the rejection of dead tissue, Iruksol ointment or other local products containing enzymes are prescribed.

To speed up the healing of open wounds, Troxevasin ointment or Methyluracil ointment is prescribed.

Recovery after surgery for phlegmon requires several months, and the patient must strictly follow the doctor’s recommendations so that there is no recurrence and the disease does not become chronic.

Complications of cellulitis

A complication is the spread of infection throughout the body through the blood or lymph, which is fraught with general intoxication of the body and the development of sepsis or lymphadenitis.

Cellulitis and abscesses of the maxillofacial area can lead to the spread of infection to brain tissue, which leads to the development of meningitis or purulent meningoencephalitis.

Cellulitis of the neck can lead to suffocation, and involvement of nearby arteries in the inflammatory process and subsequent destruction of the vessel walls causes massive arterial bleeding and death.

Prevention

Strengthening the patient’s immune system, timely and adequate treatment of boils and carbuncles, normalizing metabolism and eradicating chronic bacterial foci in the body will help reduce the risk of developing phlegmon.

Which doctors should I contact for phlegmon?

When identifying the first symptoms of phlegmon, the patient is recommended to contact a surgeon.

Dental surgeons treat neoplasms of the maxillofacial area; if the disease develops as a result of a fracture or other injury, traumatologists.

Cellulitis - ICD code 10

In the international classification of diseases, phlegmon is in class XII (L00-L99)

L00-L99 - Diseases of the skin and subcutaneous tissue

• (L00-L08) Infections of the skin and subcutaneous tissue

(L03) Cellulitis

• (L03.0) Cellulitis of the fingers and toes
• (L03.1) Cellulitis of other parts of the extremities
• (L03.2) Facial phlegmon
• (L03.3) Cellulitis of the trunk
• (L03.8) Cellulitis of other localizations
• (L03.9) Cellulitis, unspecified

Phlegmon is a diffuse purulent, less often putrefactive inflammation in fatty tissue. Its characteristic feature is the absence of clear boundaries. Cellulitis can quickly spread through the cellular spaces, moving to muscles, tendons, and bones.
It can be either an independent disease or a complication of other purulent processes (sepsis, abscess, carbuncle). Most often, phlegmon is caused by Staphylococcus aureus. In the vast majority of cases, it occurs acutely, but there are also chronic phlegmons.

Pathogens of phlegmon.

The direct cause of phlegmon in the vast majority of cases are pathogenic microorganisms that penetrate into the cellular spaces directly through a wound or abrasion or through lymphatic or blood vessels. Most often, phlegmon develops under the influence of Staphylococcus aureus, the second most common is streptococcus.
The occurrence of phlegmon can also be caused by other microorganisms. For example, in young children, phlegmon is sometimes provoked by the Haemophilus influenzae bacterium. When a dog or cat bites, Pasturella multocida penetrates the tissue, which can cause cellulitis with a very short incubation period (4-24 hours). And as a result of injury received while working with poultry, pigs, marine fish or shellfish, the bacterium Erysipelothrix rhusiopathiae can become the cause of phlegmon.
The nature and characteristics of the development of phlegmon are determined by the characteristics of the vital activity of the bacterium that caused the purulent process. Thus, streptococci and staphylococci cause purulent inflammation. And when infected with putrefactive streptococcus, Proteus vulgaris and E. coli, putrefactive phlegmon occurs.
The most severe forms of phlegmon develop as a result of the activity of obligate anaerobes - bacteria that multiply in the absence of oxygen. These microorganisms include non-spore-forming (bacteroides, peptostreptococci, peptococci) and spore-forming anaerobes (clostridia), which are characterized by extreme aggressiveness, a high rate of tissue destruction and a tendency to rapidly spread inflammation. The chronic form of phlegmon (woody phlegmon) is caused by low-virulent strains of microorganisms such as diphtheria bacillus, staphylococcus, paratyphoid bacillus, pneumococcus, etc.

Predisposing factors for the development of phlegmon.

The likelihood of phlegmon increases with a decrease in the body's protective functions, which can be caused by exhaustion, immunodeficiency states (HIV infection), chronic diseases (diabetes mellitus, blood diseases, tuberculosis) or chronic intoxication (alcoholism, drug addiction). In all of these conditions, a more severe course and rapid spread of phlegmon are observed, which is due to the inability of the body to resist infection.
The likelihood of infection, the characteristics of the course of phlegmon and sensitivity to drugs are also determined by the type and strain of the microorganism. As mentioned above, a particularly severe course is typical for phlegmon caused by anaerobic bacteria.

Forms of phlegmon.

There are five forms of phlegmon: serous, purulent, putrefactive, necrotic and anaerobic.
Serous phlegmon. Develops at an early stage. Serous inflammation predominates: exudate accumulates in the affected area, fat cells are infiltrated with leukocytes. The fiber takes on a gelatinous appearance and becomes saturated with a watery, cloudy liquid. The border between diseased and healthy tissues is practically not expressed. Subsequently, the serous form can turn into purulent or putrefactive.
Purulent phlegmon. Histolysis (melting of tissue with the formation of pus) is observed, resulting in the formation of a cloudy, whitish, yellow or green exudate. Due to the melting of tissues with this form of phlegmon, the formation of ulcers, fistulas and cavities is often observed. With an unfavorable course of purulent phlegmon, inflammation spreads to neighboring tissues (muscles, bones, tendons), which are involved in the purulent process and are also destroyed. Pus spreads through “natural cases” - subfascial spaces and tendon sheaths. The muscles acquire a dirty gray color, are saturated with pus and do not bleed.
Putrid phlegmon. Characterized by tissue destruction with the formation of gases with an unpleasant odor. With such phlegmon, tissues acquire a dirty brown or dark green color, become slippery, loose and collapse, turning into a semi-liquid, smearable mass. Putrefactive tissue decay causes severe intoxication.
Necrotic phlegmon. Characteristic is the formation of foci of necrosis, which subsequently either melt or are torn away, leaving behind a wound surface. With a favorable course of phlegmon, the area of ​​inflammation is limited from the surrounding healthy tissues by the leukocyte shaft, and subsequently by the granulation barrier. The inflammation is localized, abscesses form at the site of the phlegmon, which either open independently or are drained surgically.
Anaerobic phlegmon. A widespread serous inflammatory process is observed with the appearance of extensive areas of necrosis and the release of gas bubbles from the tissues. The fabrics are dark gray, with a fetid odor. On palpation, crepitus (soft crunching) is determined due to the presence of gas. The tissue around the source of inflammation takes on a “cooked” appearance, there is no redness.
All of the listed forms of phlegmon are acute and are often malignant. They rapidly progress, capturing more and more new areas of fatty tissue, as well as nearby anatomical formations, and are accompanied by severe intoxication.
Chronic phlegmon can develop when the virulence of microorganisms is low and the patient’s body has high resistance. Accompanied by the appearance of a very dense, woody infiltrate. The skin over the area of ​​inflammation is bluish.

Cellulitis is a purulent-inflammatory process that occurs in the subcutaneous fatty layer and is prone to rapid spread.

The article discusses the main causes, symptoms of phlegmon of the maxillofacial area, methods of treating the pathology.

Description of the disease

Phlegmon is a purulent inflammation that occurs in soft tissues.

The pathological process does not have clear boundaries, which is why it quickly spreads to blood vessels, nerve endings and organs.

Phlegmon of the maxillofacial area mainly affects bone tissue and tendons, salivary glands, and muscle tissue.

Cellulitis is a dangerous pathological condition. Due to the purulent-inflammatory process, a large amount of toxic substances enter the bloodstream, which causes general intoxication of the body.

The disease is acute, characterized by the rapid development of symptoms, against the background of which the functions of the masticatory apparatus, swallowing, and breathing are impaired in patients.

Phlegmon in ICD 10

In the international classification of diseases, phlegmon of the maxillofacial area is included in the group of diseases of the skin and skin tissue (L00 - L99). The pathology is included in the block of infectious skin diseases and is designated in the ICD by code value L 03.2.

Causes of phlegmon of the maxillofacial area

The causative agent of phlegmon is bacterial microorganisms: streptococci, pneumococci, staphylococci, E. coli

Cellulitis of the maxillofacial area is an infectious disease.

The causative agent is predominantly bacterial microorganisms: streptococci, pneumococci, staphylococci, E. coli.

Pathogenic microflora penetrates the subcutaneous fatty tissue through small skin lesions.

Most often the cause is odontogenic, but infection through the lymphatic or circulatory system is possible.

Anaerobic bacteria (clostridia) and non-spore-forming microorganisms (peptococci, poststreptococci) also act as pathogens.

The presented microorganisms are able to reproduce in the absence of oxygen. They cause the rapid development of necrotic processes in tissues.

Factors contributing to the development of the disease:

• Reduced immunity;
• The presence of allergies with severe skin manifestations;
• Acute or chronic tonsillitis;
• Carious lesions of teeth;
• Contact with aggressive substances under the skin;
• Furunculosis;
• Use of low-quality cosmetics;
• Failure to comply with hygiene standards.

Development mechanism

When an infection enters the subcutaneous environment, inflammation rapidly develops. The high intensity of the pathological process is explained by several factors.

These include:

• Rapid development of intoxication;
• Lack of an adequate immune response of the body;
• Decreased local immunity;
• The presence of optimal conditions for the growth of bacteria.

Due to the rapid development, granulation tissue does not have time to form, which should protect the source of inflammation from healthy tissue. Therefore, the pathological process spreads quickly.

Symptoms

Symptoms of inflammation occur quickly, which is explained by the short incubation period of bacteria

The nature of clinical manifestations varies depending on the location of inflammation.

As a rule, the pathology is acute. Symptoms of inflammation occur quickly, which is explained by the short incubation period of the bacteria.

Main features:

• High body temperature;
• Symptoms of general intoxication (nausea, vomiting, dizziness);
• Muscle weakness, tremor;
• Chills;
• Headache;
• Toothache;
• Decreased appetite;
• Pain when swallowing.

Important to remember! Local symptoms, such as swelling, swelling of the skin, redness, do not appear immediately. Therefore, the symptoms of phlegmon are often mistaken for other diseases. A distinctive feature is intense pain at the site of inflammation.

External signs

After symptoms of inflammation appear on the skin at the site of the lesion, local symptoms occur.

These include:

• Swelling;
• Change in skin color;
• Hyperemia;
• Cracks in the skin;
• Pain when moving;
• Formation of a purulent fistula.

Conventionally, the course of phlegmon can be divided into 2 stages. At the first stage, a dense formation appears under the skin, which is easily felt by palpation. At the next stage, the compaction softens, indicating the secretion of pus.

Types of phlegmon

Phlegmons of the maxillofacial area in dentistry are classified depending on the location.

The main types of pathology are presented in the table below:

Localization	Characteristic
Phlegmon of the temporal region	It is an inflammatory formation in the subcutaneous layer in the temple area. Accompanied by throbbing pain, the intensity of which depends on the depth of the lesion. With superficial phlegmon, severe swelling is noted. In some cases, due to temporal phlegmon, the patient cannot open his mouth normally.
Orbital phlegmon	The purulent-inflammatory process occurs in the fatty tissue of the orbit. In most cases, the pathology is one-sided. Accompanied by intense headaches, severe swelling of the eyelids, conjunctiva, and protrusion of the eyeball. Eye movement is limited. A significant decrease in visual acuity or its complete absence is possible.
Phlegmon of the subtemporal space	A purulent-necrotic process occurring in the infratemporal fossa. Occurs against the background of caries of the upper teeth. It is also possible for phlegmon to spread from the area of ​​the upper jaw and temples. Patients experience pain above the upper jaw, which radiates to the ear, temple or teeth.
Phlegmon of the peripharyngeal space	Phlegmon in this area occurs against the background of carious lesions of the lower teeth and infectious diseases. Accompanied by moderate pain that is permanent. There is an increase in local lymph nodes, difficulty swallowing and opening the mouth.
Phlegmon of the pterygomaxillary space	The pathology is localized in the area of ​​the pterygomaxillary fold. Phlegmon occurs mainly against the background of carious lesions and other dental diseases. Infection is also possible if antiseptic standards are not observed during torusal anesthesia. There is pronounced facial asymmetry. The patient is unable to open his mouth and swallow food normally. There is hyperemia of the mucous membrane.
Phlegmon of the parotid region	It occurs against the background of a purulent form of lymphadenitis, the presence of carious lesions in the upper molars. Accompanied by swelling of the tissues of the parotid region. In this case, the skin color, as a rule, does not change. There is pain when moving the jaw.
Phlegmon of the chewing area	Localized in the area of ​​the masticatory muscles (cheeks). Accompanied by severe swelling, facial asymmetry, and pain. Mouth movements when chewing are limited.
Cellulitis of the floor of the mouth	Located in the sublingual or submandibular region. Accompanied by swelling under the tongue and pain. The patient has difficulty breathing and increased salivation. The mobility of the tongue decreases due to which speech defects occur. The tissues under the tongue acquire an unhealthy shine and turn red.

Cellulitis of the jaw space occurs against the background of carious lesions and other dental diseases

Diagnostic procedures

The diagnosis is made on the basis of anamnesis and external examination of the patient. The presence of acute or chronic infectious diseases is taken into account. Auxiliary diagnostic procedures are prescribed to determine the severity of the pathology.

During diagnosis, it is extremely important to determine the type of infection that provokes the pathology. This will allow further effective antibacterial treatment.

To determine the type of pathogen, a puncture biopsy is performed, during which purulent contents are collected, which are further studied in the laboratory.

Treatment

The nature of therapeutic procedures depends on the severity of phlegmon and its location. The pathology is potentially life-threatening, and therefore requires hospitalization of the patient.

Drug therapy

Treatment involves taking medications in strict accordance with the dosages prescribed by the doctor.

The following groups of drugs are used:

Surgery

The operation can be performed during planned treatment or urgently, if the patient’s condition worsens.

Purulent phlegmon is treated surgically. The operation can be performed during planned treatment or urgently, if the patient’s condition worsens.

The presented treatment option is considered more preferable than drug therapy, as it eliminates the risk of complications and re-development of the pathology.

The main indication for surgery is the presence of an inflammatory focus and elevated body temperature of the patient.

The procedure is performed under general anesthesia. The phlegmon is opened with a wide incision, which allows for the outflow of purulent substance.

After the pus is released, the affected area is washed and disinfected. Bandages containing antibacterial ointments are applied to the incision. If the skin does not heal well, dermoplasty is performed.

Physiotherapy

The use of physiotherapeutic procedures is considered appropriate only at the early stage of pathology. Physiotherapy methods can also be used for symptomatic treatment.

Basic methods:

• UHF therapy;
• Ultraviolet irradiation;
• Light therapy;
• Ultrasonic treatment of opened phlegmon;
• Laser treatment of the wound.

Alternative medicine

Forecast

The likelihood of complications increases significantly in the absence of timely assistance

If you seek medical help in a timely manner, the prognosis is favorable.

The pathology can be successfully treated surgically, and with the help of auxiliary drug therapy, the symptoms are eliminated and the general condition of the patient is normalized.

The likelihood of complications increases significantly in the absence of timely assistance.

In such situations, phlegmon can cause conditions that threaten the patient's life.

Possible complications

Possible complications of phlegmon in the maxillofacial area include:

• Blood poisoning and septic shock;
• Impaired brain activity due to intoxication;
• Asphyxia;
• Impaired cerebral circulation due to compression of blood vessels;
• Thrombosis of the neck veins;
• Development of a brain abscess.

Important to remember! In the absence of timely treatment, phlegmon can cause a skin defect that will persist even if treatment is successful.

Prevention

The risk of developing phlegmon can be reduced by performing basic preventive measures.

These include:

Thus, phlegmon of the maxillofacial region is a severe purulent-inflammatory disease, which is characterized by the rapid development of symptoms and the rapid spread of the pathological process to healthy tissues.

If the first symptoms occur, you should seek medical help.

Phlegmon of the leg is an acute purulent inflammation of tissues, usually of an infectious nature. Such an inflammatory process is dangerous because it does not have clear boundaries, unlike an abscess or boil, and involves a large volume of tissue. First of all, adipose tissue is involved in the pathological process, then all the rest. If treatment is not started in time, ligaments and bones suffer.

This is an exclusively surgical pathology; it can only be eliminated with a scalpel.

According to ICD-10, phlegmon of the lower leg is classified in heading L (infections of the skin and subcutaneous tissue) as phlegmon of other parts of the extremities (L03.1). Phlegmon of the foot according to ICD-10 is also classified, only the inflammatory process of the fingers has a separate code.

Classification of phlegmon

Phlegmon of the ankle joint

A diffuse inflammatory process can occur as an independent disease or as a complication of an existing abscess or boil. Accordingly, they distinguish:

• primary phlegmon, resulting from direct penetration of microorganisms into tissues;
• secondary, as a complication of an already ongoing inflammatory process.

Depending on the course, it is divided into acute and chronic. And according to the type of spread of infection - damage to deep-lying or superficial tissues.

According to the morphological classification of inflammation, 4 forms are distinguished:

• serous;
• purulent;
• necrotic;
• putrid.

The exact localization of the pathological process is also important, because the treatment tactics and the volume of intervention depend on this. Based on localization, phlegmon is classified into subcutaneous, intermuscular, subfascial or diffuse phlegmon.

Types of pathogens

Opening of deep phlegmons of the sole

Despite the fact that phlegmon of the lower leg can be treated surgically, therapy is impossible without prescribing antibacterial therapy. And its choice directly depends on the type of pathogen that caused the disease.

There are two ways of penetration of the pathogen: through damaged skin or “metastatically” from other anatomical areas (retroperitoneal space, foot, thigh).

The first place among the causative agents of phlegmon is Streptococcus aureus, the second is Streptococcus.

In children and adolescents, due to undeveloped immunity, the disease can be triggered by hemophilus influenzae infection. When bitten by animals (especially domestic ones), Pasteurella multocida may enter the tissue.

The chronic course of phlegmon is caused by the proliferation of diphtheria bacillus, pneumococcus or paratyphoid bacillus.

The course of the disease itself and the type of inflammation depend on the type of pathogen.

For staphylo- and streptococci, abundant discharge of purulent contents is more typical, and if the cause of phlegmon is microorganisms of the genus Proteus or E. coli, you should expect putrefactive melting of the tissues.

Clinical picture

Severe inflammation of the skin of the leg

Phlegmon of the leg is characterized by an acute onset, with the overall body temperature rising to febrile levels (39-40 C), weakness, malaise, and symptoms of intoxication increasing.

Cellulitis (see photo) has a characteristic appearance: the skin acquires a red-gray tint, becomes hot and swollen. In this case, the lower leg can significantly increase in size, the skin becomes shiny and shiny.

At the same time, it is not possible to determine clear boundaries of inflammation; it seems to gradually disappear.

If the inflammation is productive, that is, pus is released, a cavity may form, delimited by fascia or synovial muscle sheaths. If the putrefactive process has affected the skin, a tissue defect may appear with pus coming out.

With lightning-fast development of the inflammatory process or untimely seeking medical help, complications may occur:

• inflammation of the lymph nodes and blood vessels;
• thrombophlebitis;
• sepsis;
• erysipelas.

If a large number of tissues are affected and the immune response is significantly weakened, pathogenic microorganisms may spread to other distant organs and tissues through the bloodstream.

Treatment of phlegmon of the leg

Opening the lesion with striped incisions

Before prescribing antibiotic therapy, it is necessary to identify the causative agent of the disease. To do this, a smear or piece of affected tissue is sent to a bacteriological laboratory.

To treat this disease, an integrated approach is used, that is, a combination of surgery and drug therapy.

The patient must be in a hospital setting.

First of all, the focus of inflammation is opened, sanitized and drained. Even in the absence of a cavity with purulent contents or a symptom of fluctuation, surgical treatment is prescribed. This approach makes it possible to reduce the volume of tissue and remove a large array of dead tissue with pathological organisms.

The opening of the lesion is carried out under general anesthesia with wide “lamp-shaped” incisions (photo).
This allows you to visualize the entire volume of damage and not miss “secret” pockets. To do this, it is necessary to cut not only the skin with subcutaneous tissue, but also the deeper lying muscles.

Rubber tubes or glove strips are used as drainage.

To better separate the contents, bandages with a hypertonic solution or antibacterial ointments are applied to the wound. It must be remembered that “heavy” ointments (ichthyol, tetracycline and the like) are not used in the early postoperative period! This is due to the fact that they completely cover the wound surface, significantly complicating the outflow of pus to the outside.

When a large flap of skin is excised, dermoplasty is subsequently performed.

Drug treatment

Drug treatment of phlegmon

Conservative therapy is carried out to achieve several goals simultaneously:

• infection control;
• anti-intoxication therapy;
• increased body reactivity.

Antibiotics are prescribed empirically until an answer or a bacteriological laboratory arrives. Moreover, their effectiveness is assessed after 72 hours. For anaerobic infection, it is necessary to prescribe anti-gangrenous serum.

To improve your general condition, it is necessary to detoxify the body. An intravenous drip of a Rheosorbilact solution with the addition of ascorbic acid and diuretics is used.

To improve heart function, you can add a solution of glucose or sodium thiopental to the dropper.

In the late rehabilitation period, bandages with various creams and ointments are used topically. Fat-based ointments prevent the formation of granulation tissue. Reinfection and the development of a new round of inflammation are prevented by water-based ointments.

If the infiltrate is not formed, only conservative treatment can be used.

Physiotherapeutic procedures (UHF, heating with the addition of ointments) give good results.

Prevention of the development of phlegmon of the lower leg involves preventing injuries and immediately treating even minor cuts and scratches.