Phlegmone

Bacterial, purulent inflammation of the tissue crevices, usually caused by staphylococci and streptococci.

Staphylococcus aureus and group A streptococci (rarely also mixed flora or gram-negative germs) can form unfocused abscesses and enter the bloodstream and lymphatic system via the subcutaneous tissue. This is often caused by panaritis, minor injuries, infected wounds, thrombophlebitis or erysipelas

• Warm, pasty, painful, sometimes purulent, reddened oedema, rarely with subcutaneous abscesses. In addition, lymphangitis and lymphadenitis may occur
• A severe feeling of illness and high fever
is typical

• The diagnosis is made clinically
• Bacterial smear after stab incision if atypical pathogens are suspected
• BB (leucocytosis), CRP, ESR, liver and kidney values (before planned antibiotic therapy)
• Regular control of temperature, blood sugar determination

• Thrombophlebitis
• Sepsis

• Inpatient admission
• Bed rest
• Restraint
• Elevation of the affected part of the body
• Operative incision with splitting of fascia in case of fluctuation, antiseptic irrigation with e.g.: Povidone-iodine solution and drainage/flap insertion

Topical therapy

• Moist dressings with antiseptic additives (chlorhexidine gluconate solution, quinolinol sulphate) with regular re-lubrication

Systemic therapy

• Cefuroxime p.o. 250-500 mg 2x tgl (> 12 yrs), 125 mg 2x tgl (5-12 yrs and ≥ 15 kg); i.v. 750 mg-1.5 g 3-4x tgl

• Alternatively: clindamycin i.v. 3x 600/d (particularly good tissue penetration)

In severe and resistant cases, hospitalisation

• Alternative: Gentamicin 1 time/day 240 mg p.o.
• Alternative: Ceftazidime i.v. (or i.m. (0.5 or 1 g)) 1-2 g 2-3x tgl (> 14 yrs), max. 3 g/d (> 80 yrs), 30-150 mg/kg bw/d in 2-3 individual doses (1-14 yrs), 50-100 mg/kg/d in 2 individual doses (2 m.- 1 yr), 25-60 mg/kg/d in 2 individual doses (< 2 m.)

1. Fischer V. [Colibacillary phlegmone with subsequent gangrene treated with streptomycin]. Cesk Dermatol 1949;24:159-62.
2. Fucsek M, Kovacs M, Jobbagyi P. [Orbital phlegmone caused by acute exacerbation of chronic fungal pansinusitis in a child]. Orv Hetil 2002;143:1207-10.
3. Hirama M, Sasaki T, Tokunaka H, Taneda M. [Nonclostridial gas-producing phlegmone originating in the right thigh of a diabetic patient: report of a case with autopsy findings]. Hokkaido Igaku Zasshi 1986;61:593-8.
4. Lehman E. Perirenal urinary phlegmone. Harefuah 1952;43:30-2.
5. Lorenz G. [Stomach phlegmone in a small child]. Zentralbl Allg Pathol 1966;109:512-5.
6. Vasic G, Plazineic M, Zivanovic V, Ignjatovic D. Case report: multidisciplinary treatment of a patient with gas-producing phlegmone. Acta Chir Iugosl 2002;49:85-8.
7. Schöfer, H. (2016). S2k + IDA Leitlinie: Diagnostik und Therapie Staphylococcus aureusbedingter Infektionen der Haut und Schleimhäute. Awmf.org. Retrieved 13 October 2015, from  http://www.awmf.org/leitlinien/detail/ll/013-038.html