Phlegmons L03.8

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Dr. med. Jeton Luzha

Last updated on: 16.02.2023

Definition
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Diffuse, purulent, necrotizing, bacterial inflammation (subcutaneous, subfascial, intramuscular) spreading into tissue clefts with broad tissue fusion.

S.a.

Glossitis phlegmonosa

blepharitis phlegmonosa

Necrotizing fasciitis.

Etiopathogenesis
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Frequently streptococcus (Streptodermia phlegmonosa) or staphylococcus infection (Staphylodermia phlegmonosa), also gram-negative germs and mixed flora. After minor injuries, e.g. panaritia, erysipelas, thrombophlebitis, rapid invasion of the bloodstream and lymphatic system.

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Dermatology

Panaritium

Collective term for all purulent infections of the fingers and toes.

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Clinical features
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Hot, red, painful, doughy, inflammatory, circumscribed edema. Rarely purulent subcutaneous abscesses, breakthrough through the skin. Lymphangitis and lymphadenitis, fever.

Laboratory
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Leukocytosis, BSG elevation.

Therapy
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Immobilize and, if possible, elevate affected body parts.

External therapy
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Moist dressings with antiseptic additives such as potassium permanganate (light pink) or quinolinol (e.g. quinosol 1:1000 or R042 ).

Internal therapy
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Antibiosis after antibiogram, initial dicloxacillin (e.g. InfectoStaph) 2-4 g/day in 4-6 ED. Furthermore, due to the mixed infection of staphylococcus and streptococci, effective treatment with clindamycin or flucloxacillin is possible. In severe and resistant cases, hospital admission and targeted i.v. antibiotics, initially e.g. gentamicin (e.g. refobacin) once/day 240 mg p.o. and ceftriaxone (e.g. rocephin) once/day 2 g i.v. Ultima ratio: surgical debridement

Operative therapie
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In case of fluctuation, wide incision, irrigation with antiseptic solutions such as polyvidon-iodine solution (e.g. Betaisodona), drainage/ladder insert and then antiseptic dressings with polyvidon-iodine ointment (e.g. Braunovidon).