Unlike ulcers of the internal organs, abscess of the soft tissues of the extremities is almost superficial, and its diagnosis is not complicated. But in certain controversial cases, it is necessary to resort to additional instrumental methods for diagnosis.
Abscess of the soft tissues of the limbs is formed in their cavity with pus. Most often, this pathology develops in the muscle or subcutaneous adipose tissue. The capsule cavity is demarcated from the surrounding tissue, which protects from the spread of pus in them. But with the progression of the abscess opens spontaneously it, its infected contents flow into the surrounding tissue, which can be fraught with complications.
Treatment of abscess of soft tissues of limbs – surgical abscess is opened, the pus removed. Conservative therapy is also involved, but is an additional method of treatment.
Abscess of the soft tissues of the limbs – their most common purulent pathology. The frequency of occurrence of it can compete, perhaps, only with cellulitis of the soft tissues the same location – spilled purulent lesions that has no boundaries due to the lack of a capsule. Quite often, these two things “complement” each other – the abscess may be complicated by development of cellulitis, and on the background of cellulitis can limited form ulcers.
It often happens that such an abscess is formed in the thick arrays of soft tissues in the forearm, shoulder girdle, thigh, drumstick.
Abscess of the soft tissues of the extremities can occur at any age – starting from early period after birth and to deep old age. In the latter case, the incidence is reduced, as due to age-related changes in reactivity of the tissues is reduced.
The immediate cause of the formation of an abscess in soft tissues of the extremities is a disease-causing microflora.
This may be pathogens:
- non-specific – they provoke the development of various inflammatory and infectious pathology;
- specific – these infectious agents cause only certain of infectious diseases that can be caused by other pathogens.
Abscess of soft tissues of extremities develops, as a rule, penetration of pyogenic bacteria, but magnerota pathogenic microorganisms may also trigger its development. As the results of crops, almost any infectious agent, once in the subcutaneous fat or muscle, able to run in them the process of suppuration. Most often it is the pathogens such as:
But, as shown by the results of the crops role in the formation of an abscess in soft tissues of the extremities often plays a mix of infectious agents or two or more. Approximately 25% of all cases of this disease in the pus revealed Staphylococcus infection.
Abscess of the soft tissues of the limbs may be:
In the first case of pathogenic microflora enters initially into soft tissue and provokes them fester. In the second case, infectious agent is spread into the subcutaneous fat and muscle arrays extremities of infectious foci that already exist in the body.
If developed osteo-articular tuberculosis can occur the so-called “cold” abscess of the soft tissues of the extremities. The pus flows into them from the primary tumor, the body restricts it from healthy tissue with pyogenic membrane, thus forming an abscess.
As a rule, penetration of pyogenic microorganisms into the soft tissues of the limbs occurs in the event of damage to their skin with:
- wounds – incised, chopped, stab, bite, gunshot, crushed;
- the micro – abrasions, scratches;
- burns – thermal (arise in the soft tissue of an open fire or hot liquids) and chemical (formed when exposed to aggressive chemical compounds);
- open fractures;
- medical manipulation.
Infection soft tissues of extremities with abscess formation, which is observed when carrying out medical procedures, arises if such manipulations were conducted in violation of the rules of asepsis. It often occurs in violation of the rules of sterilization of instrumentation. Such medical procedures can be both diagnostic and therapeutic.
Infection soft tissues of the extremities, followed by the appearance of an abscess most often occurs during such diagnostic procedures, such as:
- diagnostic puncture tissue;
- biopsy – sampling of tissue fragments for diagnostic purposes.
A similar infection can occur at therapeutic manipulation of the tissues – often:
- removal of tumors;
- plastic surgery.
Secondary abscess of the soft tissues of the limbs is formed in the case, if the body has already developed such an acute purulent-inflammatory diseases, such as:
- boil – purulent inflammation of the hair follicle;
- carbuncle – purulent inflammation of the hair follicle with involvement of neighboring soft tissues;
- furunculosis – the formation of multiple boils;
- carbuncles – formation of multiple carbuncles;
- abscess other locations;
- inflammation of any localization;
- pyoderma – lesions superficial layers of the skin in the form of small multiple purulent foci;
- purulent wound;
- purulent angina – the formation of pus in the lacunae of tonsils;
- pleurisy – inflammation of pleura;
- pericarditis – inflammation of pericardium (heart bag);
- peritonitis – inflammation in the sheets of the peritoneum. It is often purulent, but banal catarrhal peritonitis without sepsis can also be the cause of the ingress of microorganisms into the blood, and migrate into the soft tissue of the limbs with subsequent abscess formation.
Cause abscess formation in soft tissues of the extremities can become chronic foci of infection – often it:
- sinusitis – inflammation of the frontal sinuses;
- sinusitis – inflammation of the maxillary sinuses;
- etmoidit – a pathological process of an inflammatory nature in the sinuses of the ethmoid bone;
- steroidit – inflammation of the cells of the sphenoid bone;
- pharyngitis – inflammation of the mucous membrane lining the throat
and some others.
Theoretically any infectious outbreak in the body can become “supplier” of microorganisms for the subsequent formation of abscess of the soft tissues of the extremities.
A separate case – the formation of abscess of soft tissues of limbs with suppuration of a hematoma (collection of blood). Blood – one of the best environments for growth and reproduction of microorganisms. Initially, the hematoma itself is sterile but pathogenic bacteria, getting to her hematogenous, lymphogenous or by contact infect her.
Highlighted a number of factors that are the direct cause of this pathology are not, but are the contributing. It is such groups of factors as:
Disorder of peripheral blood circulation due to vascular problems leading to deterioration of blood supply to the tissues, they are worse than recover, also because of the suffering of local immunity – the chances of occurrence of ulcer increase.
Any failures of metabolic processes can cause the formation of abscess of the soft tissues of the limbs for the same reasons – because of violations of tissue metabolism.
Of endocrine disorders the greatest importance for the formation of an abscess in soft tissues of the extremities is diabetes – a violation of carbohydrate metabolism from lack of insulin. Patients with diabetes are particularly difficult to tolerate purulent inflammation, because tissue regeneration deteriorates from them several times.
Somewhat less important are such endocrine disorders as:
- hypothyroidism – decreased production of thyroid hormones;
- hyperthyroidism – increased thyroid hormone synthesis.
Somatic diseases play an indirect role in the development of inflammatory pathologies in General, and abscess of the soft tissues of the extremities in particular. On the background of weakening the body’s resistance to harmful effects of the infectious agent. Such enabling conditions may be diseases of any bodies:
and many others.
The risk of developing abscess of the soft tissues of the extremities is increased by reducing the resistance of the organism (local and General immunity).
The development of the pathology
An infectious agent can get into the soft tissue of the extremities in several ways:
- hematogenous through the blood;
- nodal – flow of lymph;
- contact directly migrating from neighboring tissues.
The period of adaptation of pathogens in the tissues rather short, averaging from a few hours to 1-1. 5 days. After this infectious agent aktiviziruyutsya begins to multiply and excrete their waste products in the tissue.
They, as well as the decay products of dead microbial bodies provoke irritation of the subcutaneous fat and muscle tissue of the limbs. Activated local immunity, the source of infection in the tissues do cells of the immune system, mostly white blood cells and macrophages (cell eaters, harvesting the microbial bodies). The pus which is formed during the formation of an abscess is the body’s white blood cells. Its quantity is accumulated, at the same time the body tries to distinguish purulent contents from healthy tissue as a result of pyogenic membrane is formed, there is a cavity of the abscess.
The difference between abscess of the soft tissues of the extremities and other inflammatory pathologies is the presence of the so-called infiltration of the capsule, which forms the cavity of the abscess (by its other name – pyogenic membrane). The capsule of an abscess of the soft tissues of the extremities is formed as a result of infiltrative processes in tissues, which directly borders with pus. If such a capsule were absent, the number of complications related to the spread of pus from the abscess to the healthy tissues would be increased by 3-5 times.
Pyogenic membrane has a small margin of safety – it is quite thin and easily breaks, purulent content penetrates into the surrounding tissue.
The causes of the destruction of the capsule the following:
- the accumulation of large quantities of purulent exudate – he’s getting “crowded” in the limited space of an abscess;
- the increased pressure of pus in the abscess;
- thinning of capsule tissue are attacked by elements of the immune system organisms.
At the break of the abscess, the pus penetrates into the surrounding tissue or intermuscular spaces of the affected limb on the principle of least resistance, although in some cases it “paves” the road in the form of a fistula (abnormal speed), corroding soft tissue.
Abscess of the soft tissues of the limbs is a typical inflammatory process. It is characterized by local and General manifestations.
Local symptoms described disease is:
- redness of the skin over the abscess;
- increased local temperature of the body;
- pain syndrome;
- dysfunction of the limbs.
Characteristics of pain:
- localisation the ulcer;
- distribution – first local, and then can reach the surrounding tissue;
- nature – twitch;
- intensity – first the weak, the accumulation of pus increase;
- the appearance – develop almost immediately with the abscess formation.
A small ulcer did not significantly affect the functionality of the upper and lower extremities. But when a large amount of motion in the joints can be accompanied by severe pain, causing the patient to spare them, therefore, limits the level of activity of the affected limb.
If the abscess is located in the soft tissues superficially, described the symptoms clearly. In severe adipose tissue, as well as the formation of an abscess deep in the muscle arrays local symptoms may flatten, the more pronounced are the common symptoms that confuses the diagnosis.
Signs of violation of the General condition of the body occur because of intoxication syndrome – due to contact with toxic products of vital activity of microorganisms in the blood and in other organs and tissues.
Symptoms of the following:
- the increase in body temperature to an average of 37.8-38.5 degrees Celsius. Sometimes the body temperature can rise to 40 degrees and be accompanied by chills. This can occur when large amounts of ulcer or high pathogenicity of microorganisms (ability to provoke an infectious process);
- the deterioration of disability – equally physical and mental;
- deterioration of appetite.
The diagnosis is based on patient’s complaints, medical history data (past infections, medical procedures, injury and so on), as well as additional research methods.
In the physical examination study determined the following:
- during the inspection – the area of the abscess swollen tissue swelling of the limbs may be disproportionately higher than the abscess. The skin in the affected area hot to the touch. At a superficial location of the abscess and the overflow cavity of abscess pathological masses the skin over the abscess thins out, under it is visible pus;
- palpation (feeling) – swelling of the soft tissue palpation is confirmed, determine the increase of local body temperature and soreness. It is also noted fluctuation characteristic “waves” under your fingers when pressing on the location of the purulent focus.
At the request of the doctor to make the movement of a hand or foot, the patient spares the affected limb.
Instrumental methods that may be useful in the diagnosis of abscess of soft tissues of the extremities is:
- diagnostic lumbar puncture is performed when there are symptoms of intoxication, but the local signs of abscess is highly questionable. This may occur in deep location of the abscess in the soft tissues of the extremities. In this case, after the treatment the skin over the abscess is carried out puncture of the soft tissues with a sterile needle on the syringe, pus if present was aspirated and sent for laboratory examination;
- ultrasound examination (sonography) is performed with the same purpose;
- x-ray examination is performed at suspicion on the formation of a “cold” abscess.
Laboratory methods used in the diagnosis of abscesses soft tissues of the extremities, the following:
- General blood analysis – a substantial increase in the number of white blood cells indicates the possibility of occurrence of purulent process in the body. There was also an increase in ESR;
- PCR diagnosis of tuberculosis – is carried out in cases of suspected tuberculous origin of the abscess;
- bacterioscopic study – punctate examined under a microscope, it identificeret infectious agent that triggered the formation of an abscess;
- bacteriological examination – make a sowing punctate on a nutrient medium, grown colonies make a conclusion about the type of pathogen. Also using this method to determine the sensitivity of the pathogen to antimicrobial drugs, which has implications for follow-up appointments.
Differential diagnosis of
Differential diagnosis of abscess of soft tissues of the extremities is carried out with such diseases and pathological conditions, such as:
- tumors (non – malignant and malignant);
- foreign body;
Most often develop following complications of an abscess of the soft tissues:
- arrosive bleeding arises from the fact that the suppurative process erodes the wall of the blood vessel;
- neuritis – inflammation of a nerve, which may occur if involved in a pathological process of the nerve trunk;
- lymphadenitis – inflammation of lymph nodes;
- lymphangitis – inflammation of lymphatic vessels;
- osteomyelitis – purulent fusion of bones to be;
- arthritis – inflammation of the joint, which is located near the abscess of the soft tissues of the extremities.
Treatment of abscess of soft tissues
Abscess of the soft tissues of the extremities eliminate with surgery. If the abscess is small, it opened in the festering bandaging surgical hospital or outpatient Department. Large abscesses and those that are deep in the muscular areas of the limbs, expose the festering operating conditions, as may be necessary anesthetic management.
The scheme of operation is as follows:
- make the cut tissue over the abscess;
- the pus is removed;
- reviewing cavity on the pockets;
- connective tissue bridges in this ruin;
- carried out reorganization of the cavity of the abscess using aseptic solutions;
- the cavity of the abscess drained – it is administered in a PVC tube, the free ends of which are output to the outflow of residual liquid;
- the wound is not sutured, sometimes a few stitches applied for the information of its edges, so she’s not gaping;
- impose aseptic bandage.
Appointments in the postoperative period following:
- the rest of the limb;
- antibacterial drugs taking into account susceptibility to antibiotics;
- vitamin therapy;
- infusion therapy is carried out in marked intoxication syndrome. Intravenously administered saline, electrolytes, blood plasma, fresh-frozen serum.
Methods of prevention of this pathology are:
- timely treatment of wounds;
- timely and appropriate treatment of burns, frostbite, open fractures;
- strict adherence to aseptic technique when performing medical procedures;
- prevention, timely detection and elimination of foci of infection in the body;
- treatment of vascular, metabolic, endocrine, somatic diseases that may contribute to the development of an abscess;
- strengthening the immune system.
The prognosis of abscess of the soft tissues of the extremities generally favorable. Complications develop only in the late treatment and complications of the disease and when self – in particular, when “wykrawanie” abscess.