I
Etiology Stages Obligatory
Recommended
Surgical
treatment:
Opening
of the apostasis,
necrectomy,
drainage
Regional
resection of the nail
Perforation of the nail
Ablation of the nail
ампутація Opened
method Sami-open
method Closed
method Panaritium
Microtrauma
St. Aureus - 85%
St. Aureus в асоціаціях - 10%
Serous infiltrate
Desquamation of the epidermis with accumulation of an exudate
V.
Table of contents of teaching
T
Diagnostic methods Treatment
Purulent
necrotic stage
Purulent necrotic
Dermal
panaritium
Clinical
forms
Agnail
Subungual
Paronychia
Paraungual
Inflammation
of the paraungual roller Inflammation
of the roller by lateral edges of the nail Accumulation
of the pus under nail
Lymphatic
Inflammatory
process extends
on lymphatic vessels
Subcutaneous
Inflammation of the
subcutaneous cellular tissue
Tendinous
Inflammation of the tendon
sheath and tendon
Osseous
acute and chronic
Purulent inflammation process
of the bone tissues
Articular
Inflammation
of the capsule of the interphalangeal joint
Osteoarticular
Inflammation
of the capsule,
articular
surfaces
and bodies phalanges
Pandactylitis
Purulent inflammation of all
tissues of the finger
Facultative
Anamnesis
Investigation of the areas
of sickliness
Determination of the
crepitation
X-ray
Bacteriologic
research
Thermography
Fistulography
Conservative:
general and local antibiotic therapy,
immobilization
Serous
stage 
Postoperative treatment
V. Reference basis of an action
The algorithm of the choice of the method of the anesthesia at differed forms of the panaritium
Clinical forms of a
panaritium
Dermal
panaritium
Anesthesia
isn't need 
Lymphatic
Deep
necrotic damages
Agnail
Subcutaneous Oberst-Lucashevich's
anesthesia
Localization
of the process
Articular
On the
nail bone or middle phalanx
Osteoarticular Usolceva's
anesthesia
On
basic phalanx
Osseous
acute and chronic
Pandactylitis General
anesthesia 
Tendinous
The algorithm for determination of sickliness areas at panaritium and
phlegmon of the hand
|
№ |
Task |
Indication |
Comment |
|
1 |
Determinate the area of the sickliness at panaritium |
|
The investigation should be executed cautiously without any extra injury of the patient
The purulent fistula on the finger shouldn't be probed without of the anesthesia |
The algorithm of differential diagnostics of the panaritium and others purulent processes of soft tissues of the finger
The algorithm of choice of an incision at different localizations of a phlegmon of a hand
A skin abscess – it is a longitudinal linear incision through a purulent hearth with the delete of the exfoliated epidermis.
A phlegmon of hypoderm – it is a linear incision through the most prominent part of the purulent hearth.
An interdigital phlegmon (commissural) – it is a incision at the level of the proper interdigital spaces on the palmar surface of the hand
A phlegmon of middle space of the hand – it is a longitudinal incision which passes according to an interval between 3-4th metacarpals.
A phlegmon of a thenar – it is a incision on the palmar surface of the hand on a plica which surrounds muscles of the tenor (the incision in the proximal part of the palm is not led to the end of the plica, it is a danger for a damage of the middle nerve).
A phlegmon of a antithenar – it is a longitudinal incision on palmar surface above the most prominent part of the antithenar.
A phlegmon of the tergal surface of the hand –it is longitudinal incision on the tergal surface of the hand above the projections of interdigital spaces (look pictures)
P
icture
1
Incisions in time of a opening of a phlegmon of a hand.
а – It is Isolen's incision of the thenar
б – ItisKanavel'sincision
в – It is Pick's incision of the deep palmar space (the projection of the middle palmar space is demonstrated by the dotted line)
Picture 2
T
here
are openings of purulentvaginal synovitis
(Kanavel). Incisions at expansion
of a
purulent process
on cubital and radial bursas are demonstrated by the dotted
line.