Soft tissue abscess is a cavity located in the muscles or subcutaneous fat, separated from the surrounding tissues and filled with purulent contents. It is characterized by the presence of edema, hyperemia, skin soreness and a symptom of fluctuation in the affected area. It is accompanied by general somatic changes: headache, hyperthermia, malaise, sleep disorder. The examination includes examination, ultrasound, radiography, diagnostic puncture of the abscess and bacteriological examination of its contents. After the formation of the abscess, its opening is performed, followed by postoperative drainage and washing with antiseptic solutions.
ICD 10
L02.2 L02.3 L02.4 L02.1
General information
Soft tissue abscess differs from other purulent-inflammatory diseases by the presence of an infiltrative capsule (pyogenic membrane). The capsule restricts the abscess from nearby anatomical structures and prevents the spread of the purulent process. However, the accumulation of a significant amount of purulent exudate, an increase in the abscess and thinning of its capsule can lead to a breakthrough with the release of purulent contents into the surrounding tissue or intermuscular spaces and the development of spilled purulent inflammation — phlegmons.
Causes
Soft tissue abscess is caused by the ingress of pyogenic microorganisms into the tissues. In about a quarter of cases, the pathology is caused by staphylococcal infection. Pathogens can also be Streptococci, E. coli, Proteus, Pseudomonas aeruginosa, Clostridia, etc. pathogenic microorganisms. Polymicrobial etiology is often noted. With bone tuberculosis, there may be a “cold” abscess caused by mycobacteria. The main causes of the disease:
- Traumatic injuries. The penetration of pyogenic microorganisms more often occurs when the integrity of the skin is violated as a result of wounds, injuries, microtrauma, burns, frostbite, open fractures.
- Remote foci of infection. Soft tissue abscess can occur when microorganisms spread lymphogenically and hematogenically from purulent foci present in the body, for example, furuncle, carbuncle, pyoderma, etc.
- Medical manipulations. Infection can occur iatrogenically during injection with an infected needle.
- Corrosive liquids. In rare cases, there is an aseptic abscess that occurs as a result of liquids (kerosene, gasoline, etc.) entering the tissues causing their necrosis.
Risk factors
According to the observations of specialists in the field of purulent surgery, the favorable background is:
- the presence in the body of a focus of chronic infection (sinusitis, chronic tonsillitis, pharyngitis);
- long-term gastrointestinal tract disease (gastroenteritis, enteritis, colitis);
- peripheral circulatory disorders (with atherosclerosis, varicose veins, post-thrombophlebitic disease);
- metabolic disorders (obesity, hypothyroidism, vitamin deficiency).
Diabetes mellitus with severe angiopathy plays a particularly significant role in the development and progression of the purulent process.
Symptoms
Soft tissue abscess is characterized by the presence of local and general somatic symptoms. Local signs include soreness, swelling and redness of the skin area located above the abscess. Pressure in the affected area causes increased pain. With a superficial location, the local symptoms are clearly expressed. A few days later, a symptom of fluctuation appears, indicating the accumulation of liquid contents inside the inflammatory focus.
With a deeply located abscess, local symptoms are not so noticeable, there is no fluctuation, changes in the general condition of the patient come to the fore. The general somatic signs are nonspecific. Patients note increased fatigue, periodic headache, fatigue, sleep disturbance, a rise in body temperature, which can reach 39-40 ° C and be accompanied by chills.
Complications
It is possible to spread the purulent process with the development of sepsis, which poses a threat to the patient’s life. Other complications of an abscess are:
- phlegmons of soft tissues spreading through the intermuscular and cellular spaces;
- purulent melting of the wall of a nearby large vessel with the occurrence of bleeding;
- involvement of the nerve trunk in the process with the formation of neuritis;
- the spread of the process to solid structures with the development of osteomyelitis of the nearby bone.
Diagnostics
During the consultation, the purulent surgeon draws attention to the presence in the anamnesis of indications of the appearance of inflammatory symptoms after an injury, injury or injection. To identify background diseases, a therapist and other specialists are involved according to indications. The examination plan includes the following diagnostic procedures:
- Objective inspection. A superficially located soft tissue abscess is easily detected when examining the affected area. Local sharp soreness, edema, hyperemia and hyperthermia are determined, in some cases fluctuation is detected.
- Additional research. Deep abscesses require soft tissue ultrasound and diagnostic puncture. The resulting material is subjected to bacteriological examination to determine the sensitivity of the purulent microflora to antibiotics. If a “cold” abscess is suspected, an X-ray examination of the affected area and a PCR diagnosis of tuberculosis are performed.
Treatment
The main method of treatment is operative. Tactics are determined by the localization, volume and stage of the purulent process, the presence or absence of complications. With small superficial abscesses, outpatient monitoring is possible. Hospitalization is necessary in case of relapse, the presence of complications and severe background diseases, the detection of anaerobic infection, a high risk of the spread of purulent inflammation with the location of the abscess on the face, near large vessels and nerves.
Conservative therapy
In the initial stage, conservative measures are recommended: anti-inflammatory drugs and UHF. Subsequently, drug therapy is used in addition to surgical treatment. Antibiotics of a wide spectrum of action are prescribed, after receiving the results of the back-examination, the scheme is adjusted taking into account the sensitivity of the pathogen. With the generalization of infection, it is necessary to carry out massive antibacterial therapy, detoxification, infusion and symptomatic therapeutic measures.
Surgical treatment
The formed soft tissue abscess is subject to mandatory surgical treatment. Autopsy and drainage is usually performed by a surgeon in an outpatient operating room. Open and closed surgical treatment of an abscess is currently used in surgery. Closed intervention is performed through a small incision, includes curettage of the walls and aspiration of the contents of the abscess, the use of a double-light tube for drainage, active aspiration and flushing of the cavity after surgery.
The open method of treatment involves emptying and washing the abscess with an antiseptic after its wide dissection, drainage with wide strips, daily postoperative toilet of the abscess cavity and dressing. No stitches are applied. After the rehabilitation of the focus and the formation of granulations, ointment dressings are used. The wound heals by secondary tension.
Prognosis and prevention
With timely adequate treatment, the prognosis is favorable. Later seeking medical help can cause the development of dangerous complications. Prevention of abscess formation consists in compliance with the rules of asepsis and injection techniques, the use of only disposable syringes and needles, timely treatment of purulent processes of various localization, increased nonspecific resistance of the body, adequate thorough primary treatment of wounds with traumatic injuries.
