Foreign body in the leg of the symptoms. Foreign bodies
Some people often complain that they constantly feel some pebbles in the foot, which does not disappear anywhere. And here the shoes are not to blame, because this "pebbles" is actually a neurom of Morton.
The reasons
Nerurom Morton is benign education In the foot, which occurs in the field of nerves, which innervate the feet of man. It occurs most often between the bases of 3 and 4 fingers. The disease is most often found on one leg, but it is very rare to detect the same formation at the second foot.
Most often, such a notch is diagnosed in women. Men have a big rarity. And the main reason here is a flatfoot, in which the nerve is compressed with tight bones. The same can be noticed with a constant wear of the shoes on high heels and with a narrow nose, when the stop, or rather, the fingers are greatly solemn up throughout the day. Another reason is a fracture of the fingers or the formation of hematoma after the injury at the point of passage of the nerve.
Much less often, the cause of the tumor becomes when they are literally cleaned by cholesterol plaques and blood can not flow normally. In some cases, the cause can be a long run or walking, at which there is a large load on the arch of the foot.
Symptoms
At the very beginning of the disease, patients make complaints about the permanent sense of numbness and pain in the foot. In addition, when wearing narrow and close shoes, as well as high-heeled shoes arise strong discomfort. The same thing is noted during long walks on foot or jogs. Another diagnostic symptom that helps to put the correct diagnosis is a strong and sharp pain when squeezing the foot with your hands. And one more sign is a sense of a foreign body in the field of forming the neuromy.
The pain that occurs during a long walk is particularly strong. But a simple foot massage will help here. However, it will not save from the disease itself and the next time everything will repeat again.
These symptoms can enhance, it is made to disappear, and such an alternation can last long. The neurom gradually grows and squeezes the nerve more and more. And this means that soon the pain will be permanent, regardless of which shoes there is a person. When making a diagnosis, other diseases should be excluded, for example, arthritis or fracture. To put the correct diagnosis, it is worth conducting a radiographic examination or MRI.
Therapy
If the disease occurs in light formIt is better to use conservative therapy, that is, treatment with medication. The most important thing is to exclude the pressure on the nerve, which causes strong pain. In the treatment of Nesters Morton, it is worth using such methods:
- Shoe change. It is worthwhile to wear only such boots or shoes that do not squeeze your fingers and have a wide nose.
- After the consultation is better to purchase orthopedic insoles or orthopedic shoes with special supinators.
- Reducing pain sensations It is worth trusted medicinal preparations, for example, apply ibuprofen, ketorolac.
If these medicines do not help and pain torments a person constantly, then it is worth thinking about the use of glucocorticosteroids. However, it is impossible to prescribe such medicines. In most cases, such treatment at the very beginning of the disease gives a good result.
Treatment of noncross folk remedies unable to cure the cause of the disease itself - availability benign tumor. However, some natural drugs Capable to reduce pain during walking or running. For this purpose, dressings are perfectly fitted with a cashie from wormwood. For warming the affected place, you can use the compress of fat and salt. But before starting to be treated in this way, it is necessary to consult with the doctor.
Operation
If a conservative methods Do not give the desired result, then resort to the operational removal of the necris. The operation is carried out under local anesthesia and does not take much time. The operation is small and the next day a person can start to walk on its own. But this is possible only when using special racks. However, it must be remembered that if provoking factors will not be excluded in the future, then the disease will return again. Therefore, for the prevention of the disease, it will be necessary to exclude all the factors that can provoke it.
Foreign bodiescalled alien organism objects that have fallen in soft fabrics, cavity or natural holes.
According to the mechanism of hitting and localization distinguish:
- forest bodies of soft tissues;
- forest bodies of cavities (chest, abdominal);
- foreign bodies of organs (for example, eyes);
- the foreign bodies of the gastrointestinal tract.
In the practice of an outpatient surgeon, fry bodies of soft tissues are most often found.
The main cause of hitting foreign languages In soft tissues - household or production injury. Foreign bodies can be in the form of a pinch (bypass), glass, metal chips and MN.
Symptoms, diagnosis of foreign bodies.
In the location of the foreign body, there is always a wound (from point to quite large). Patients complain about pain, sometimes the foreign body can be seen under the skin or it is determined by palpatorially. In some cases, it is only possible to assume the presence of a foreign body in tissues (for example, with multiple cuts of glass fragments).
If the foreign body is X-ray (metal - always, other materials - not always) the diagnosis helps to clarify X-ray examination.
In the photo - the foreign body - the chip of the needle in the soft tissues of the finger of the brush.
In the photo - a foreign body - a bullet from a pneumatic rifle in the finger of the brush.
When a foreign body gets into the tissue around it, abscess begins to form. In the area of \u200b\u200bfinding a foreign body, pain appear and grow pain, edema, redness. Can form purulent fistula, which does not heal, because The process is supported by a foreign body. Fistula will exist until the foreign body rejected itself or will not be deleted surgically. In some cases, small foreign bodies are encapsulated without suppuration. After encapsulation, the risk of suppuration in a later date remains. Around old encapsulated foreign bodies can begin chronic inflammation, manifest itself with moderate pain and formation around the foreign body of the seal - granulomas.
Treatment with foreign bodies - removal of the foreign body.
The main method of treatment is surgical. Soft fabrics are removed under local anesthesia. In some cases, when one end of the foreign body protrudes, it is possible to remove a tweezers or a clamp without anesthesia. In other cases, the foreign body is removed through a cut. It should be remembered that small foreign bodies are quite difficult to detect in tissues. Therefore, the operation should be resorted when the foreign body is clearly palpable or shines through the skin, or can be seen on an x-ray. Otherwise, the option is not excluded that the body will simply be found during the operation. If there are doubts about the presence of a foreign body or the impossibility of determining its accurate localization, observation is carried out. In the case of suppuration, they make an operation, and usually the foreign body is easily detected in the epicenter of the suppuration. When forming the granuloma, it is excised together with the foreign body.
TO MAKE AN APPOINTMENT
From everyday practice it is known that foreign bodies are often embedded in a brush. They make up 1.7% among damage. Once in the tissue, the foreign body causes a reaction from the surrounding tissues. Further flow depends on the infection and condition of the organism-lined with the foreign body. If the foreign body is aseptic, it is gradually encapsulated and can be in the brush for many years. However, in the tissues surrounding the foreign body, a dormant infection is often preserved, and a painful process may occur after many years. We give one of our observations.
45-year-old woman N. Directed to us to consult a neuropathologist about the right-hand plexitis, which is not inferior to a long and diverse physiotherapeutic treatment for five years. The cause of the disease is unknown to it, first the pains were localized in the brush, and then they spread across the arm, shoulder and neck. A few days ago, pains in the brushes were aggravated, swelling appeared at the base of the maiden.
In case of inspection and feeling, the skin was found: the sinusiness and pastosity of the skin, the smoothing of the relief of the elevation of the maiden and the wrist of the right hand, the soreness and thickening of the V of the Metal bone, the sparesiness of the soft tissues at the base of the palm, the restriction of bending, the lead, and bringing the mapleza. Hyperesthesia skin, muscle atrophy with the type of elbow nerve damage. With a diagnosis of "chronic osteomyelitis V of the Metal Bone", the patient is aimed at X-ray examination. X-ray diagnosis: a foreign body in the thicker of a pineal bone, reactive osteoperity.
Operation: After skin preparation, a V Minnal bone is naked under local regional anesthesia. The periosteum is thickened, fasting with soft tissues. The bone is easily treated, from a bone marrow cavity, an needle covered with corrosion is removed from the granulation tissue. Granulations are removed, the cavity is dismantled, powdrates, a deaf layer of wounds, immobilization of the brush and the forearm of the gypsum lopeury. Healing is smooth, pain in hand decreased. The patient remembered that the needle entered his hand during laundry laundry 25 years ago. Surgeons more often have to remove metallic foreign bodies from the brush: needles, pieces of wire, metal, less frequent bones, wooden, glass and other items.
Detect and clarify the location of contrasting foreign bodies at x-ray study It is much easier than to recognize non-contrast bodies introduced into the tissue. Radiography brushes is required both in that, and in another case, since it is sometimes possible to catch a light shadow on the film and from fish bones, and from glass or wooden. A lot has been proposed different ways Clarifying the localization of foreign bodies, but for the brush, the most simple and reliable are radiography in three projections and x-ray. At the same time, the point of the greatest immersion of the foreign body is found when pressed, the sterile needle is supplied to the foreign body, and then convenient access is determined. Therefore, during radiography, the presence of a surgeon is always recommended. A direct snapshot is done in the brush position corresponding to what it will have on the operating table; The second shot is in a strict lateral projection, it gives an idea of \u200b\u200bthe depth of the foreign bodies.
Foreign bodies are more often delayed in a flash - 47%, then in the fingers - 36.8%, less often in the wrist - 10.1%. Occasionally mainly when firearmsThey are scattered throughout the brush - 2.5%, and at 3.6% localization is not clarified. Most surgeons believe that not all foreign bodies are immediately removed. The exception is only graphite, paint pieces to be removed due to the danger of tissue necrosis caused by them.
Indications for the removal of the foreign body from the brush we formulate so. Substantly delete foreign bodies: 1) visible eyes and easily tested; 2) impellent movement in the joints or leaving slipping tendons; 3) causinggulling on vessels and nerves; 4) Supporting inflammation and 5) focusing the patient's attention.
Matter time and technique operational intervention. Of course, it is most advisable to remove foreign bodies immediately after injured. But this operation can be performed only if the surgeon has the appropriate time and conditions for intervention, since this operation is often more difficult than supposed. It's hard to find fucking needles in the ray thicker thumb, In intermetal spaces, in the wrist canals. Many times we ourselves repented in the hasty of the intervention and took the victims of others medical institutions For repeated operations, when the surgeon or the surgery of the operation was not prepared enough. Therefore, in the order of emergency operation, only the apparent eye is removed and easily tested foreign bodies.
In other cases, the removal of foreign bodies from the brush is a planned operation that requires preliminary preparation of the patient and surgeon.
Operation Plan: Infiltration Anesthesia is not recommended, since the injected novocaine displays the fabric. Regional, conductive, intraskoye or intravenous anesthesia or general anesthesia, and overall disbelief should be applied. The skin incision is carried out above the foreign body in the longitudinal or oblique direction depending on the localization. After dissection of the skin and fiber, the edges of the wound are stitched with silk. These "holders" allow you to reveal the wound and before dissection of the aponeurosis carefully examine it.
Practice shows that with properly selected access on the aponeurosis there are a dark point, or a scar, or infiltrated tissue, indicating the path of the ingotable body. Note that several times, looking at the wound with the naked eye, we did not notice the indicated signs. Inspection with a magnifying glass helped to figure out. After examination of the aponeurosis, the latter dissect and the tissues are carefully examined again.
So, in a layered in a layering, the surgeon is looking for a foreign body where they defined it with a presets. If necessary, go through the tendon vagina or muscles to avoid the violent separation of them and dissect fabrics, consistent with the anatomical ratios.
Sometimes the foreign body succeeds in trying in the wound with a finger, but also feeling must be carried out very gently and methodically, comparing with the topographic-anatomical picture of the operated region. Finally, with failed search, it is important to stop the operation in time, without moving the limit of the admissibility of injury to the tissues, followed by functional disorders. Among our observations there are cases of severe purulent infection after removing the needle in an unfavorable setting.
Removal of foreign bodies from under the nail. Under the nails fall wooden offices, pieces of fish bones or needles and other items. The foreign body under the novel causes acute pain And often visible by the eye, so the victim (or some of the loved ones) is trying to remove it and climbs the free end and only after that he turns to the doctor.
Fig. 141. Foreign body (window Casov) in the proximal interphalating joint of the finger of the left brush.
In such cases, it is recommended to produce a wedge-shaped replay of the nail, freeing the end of the foreign body so much to capture it with tweezers, and remove with smooth motion. After removal, the wound, the wound is lubricated with iodine tincture, powdered with streptocide and is stuck with a college. The bandage changes may rarely, until it grows the nail.
Healing of the operating wound after the removal of foreign bodies in 88.9% of patients occurred primary tension, 7.5% - Secretary tension, 3,6% of these information in the history of diseases is not. Before the operation of removal of the foreign body, a preventive dose is introduced - 1500 ae anticipating serum. When removing foreign bodies from the brush there are difficulties not only in finding them, but also from tissue. We give one of the observations.
W. stampers L.. The index finger came under the stamp, and the next part of the "window grab" was driven into the proximal interphalating joint of the finger (Fig. 141). On the healthy, unsuccessfully tried to remove the item, after which the victim was delivered to the hospital. She complained about brignishing pain in his entire arm. Operation under anesthesia. The item had to knock out from the rear to the palm of the eyes of the chisels and chisels. After removal of the part, there is a resection of the epimetafiosis of the middle phalange, sewn the tendon of a deep bent, compared to fragments proximal phalanx, the finger is appreciated functional position, the seams are applied to the wound; Immobilization of brush back gypsum Longeta. Wounds healed without complications. The finger is in a functionally advantageous position, passively moved in interphalating joints. Treatment continued 32 days. Was it worth preserving an index finger of the left hand of a 50-year-old worker when screaming the proximal interphalating joint and damage to the tendons of flexor and finger extensors? I answered this question three years after the injury itself was injured: "My finger works fine, almost no one notices, and I forget that it does not bend himself."
The average number of disability days with foreign bodies of the brush is 9.9.
Ring removal
When damaged and with purulent diseases of the fingers and brush, it is necessary to remove the ring from the finger. If there is no reactive edema, it is enough to raise the patient's hand and hold 3-5 minutes in this position, a slightly massaging finger from the distal phalanx to the proximal, then lubricate the skin with vaseline oil, and the rotational movements can be removed.
Fig. 142. Removal by offering from under Notagia (A); Removing ring with threads (b).
Otherwise, this is the case if the patient has suffered from pain for several days, the brush and fingers are eaten, the ring crashed into soft tissues and when trying to promote it sharply sharply sharply. The patient demands that the rings are dried or saw. This manages, if the ring is "hollow" or very thin; In most cases, the ring is not perove. It is possible to repel it if there is a file in the surgical office and manual vice.
If these tools are not, then this attempt is unsuccessful, and the patient is sent to the jeweler. Meanwhile, the ring is removed almost always with a silk thread. A thick silk thread is taken with a length of 50-60 cm, and one end is carried out under the ring from the nail to the base of the finger. A long end is tightly wound on the finger turnover to the turnover so that no millimeter of the skin remains, not the thread from the ring to the nail. The finger is lubricated by sterile vaseline oil. After that, the end of the thread, supplied under the ring, is stretched, driving through the ring, and the thread is slowly unwound. The ring under the pressure of the thread moving along it along it is moving and gradually clenches (Fig. 142).
E.V. Soltseva, K.I. Mashkara
Surgery of diseases and damage brushes
11886 0
Skin and soft tissue bodies
A wide variety of foreign bodies are embedded independently or are introduced by children into the skin and soft tissues usually during crawling or games. These items are more often contaminated, and therefore chicken wounds Must be treated as infected in most cases. Therefore, it is necessary to prescribe antibiotics, guided by the sizes of the wound and its degree of pollution. The prevention of a tetanus is also being carried out, determined by the character of the vaccinations previously received by the child.Often the question arises - to delete or not remove the foreign body? As a rule, if a little time has passed after injury and the foreign body is clearly determined, it must be removed. On the other hand, in the absence of symptoms, the risk of operation produced in order to remove, exceeds the risk associated with finding a foreign body, and therefore it is better to leave it in place. In any case, the solution to this sometimes a difficult question depends on the nature of the foreign body and its localization.
The diagnosis is usually placed on the basis of anamnesis. However, sometimes the child or parents are not sure whether injury really had. An ordinary radiograph identifies not all foreign bodies. Essential assistance in discovery of glass, plastic objects and wooden puppies can have xero (ELEKH) X-ray and soft radiography.
A study in the transmitted light (transylllumination) of small parts of the body, such as fingers, hand, leg, brush, feet, also helps determine the presence and localization of the chips and the zoom. In cases where foreign bare is deeply in the muscles or subcutaneous fatty cells, the study must be carried out in two projections, regardless of which method is applied.
If only the foreign body is not entirely superficially, then young children are most efficient and least transitically removed under general anesthesia. In older patients with manipulations on the brush and the foot, the regional blockade can be applied. Local infiltration anesthetics should be avoided, for it leads to the appearance of swelling, sometimes small bleeding, as well as some tissue offset, which can complicate the already difficult task.
Especially difficult to remove small short pointed items, such as needles, because during operation they are easily displaced and migrate to the depth. Much easier and more expedient to remove them using general anesthesia And keeping interference under the control of the screen in the operating room. The incision should be small. A clamp is introduced through it, directing directly to the needle, which captures and, carefully maneuvering, extract.
Wood foreign bodies. The tree is almost always contaminated, and therefore it should be removed to prevent infection with its infection. Around the inlet is usually marked by pain and hyperemia of the skin. If the pinch is visible, you can use local anesthesia and remove it, capturing the clamp or by excision of tissues through a small incision directly above it. Deeply sumps or residues of partially remote foreign bodies should be primarily localized with x-ray radiography.
If there are multiple small pieces, it is rationally not to search for each, and excised the wound channel and all the affected soft fabrics containing foreign bodies if localization allows you to do this. The off-in-bloods under the nails of the fingers or legs should be removed by the wedge-shaped excision of the nail coating foreign body. It turns an anaerobic wound into aerobic and, moreover, the entire fragment with this method can be removed without difficulty.
Metal fragments in size usually less wood chips and cause a less pronounced reaction. They are particularly difficult to detect, as they can penetrate deep into soft tissues. Radiography practically always reveals metal foreign bodies. If they are not defined clearly, they should not be deleted.
The needles or parts of the needle during localization in soft tissues in the field of palm or feet can cause serious concern. They come in through a small risk and can penetrate deeply, migrating with any movement. If the X-ray foreign body is detected, the limb should immediately be immobilized. For successful removal, general anesthesia is needed, the imposition of a harness, which allows the manipulation of bloodless, and the ability to use the X-ray screen as described above.
Sometimes in soft tissues, the injection needle broke during medical manipulation, these needles are usually sterile and do not require urgent removal except when their extraction does not represent complexity or when the patient has any symptoms.
If the needle incorporated during the lumped puncture remained in the field of spine, then after X-ray control, there is an operation, which may not be only long, but sometimes even to reflect the removal of the vertebrae or an accelerated process.
Fishing hooks are usually embedded in the fingers or in the palm. Their teeth make it difficult to remove. The fishing hook can be removed without much difficulties, if you promote it with a sharp tip forward, to buy through the skin and cut the tooth.
Pieces of glass are often embedded in children in a brush or foot. In some cases, small fragments that have fallen "splashes" on the face or body can be removed using a sticky plaster. Xerordgenography usually reveals pieces of glass only significant sizes in soft tissues. However, they are extremely difficult to detect on operations. And since they are usually minimal inflammation, they are removed later if pain or persistent signs of infection appear.
K.U. Ashkraft, TM Holder
Life is full of surprises. And such, it would seem, small problems as a non-blood, chips, needles, glass fragments, metal chips, and much more can lead to unpleasant disappointing consequences. The rich life of the city sometimes leaves no time for himself, but this time must be found, at least in order to contact a specialist if something happened.
Foreign bodies, falling into soft tissues, can stay there for a long time, unless of course accompanied by the development of infection, and they forget about them. But it is rare. Most often in the field of foreign bodies in the fabric, the suppuration occurs. Binding - inflammation, in the focus of the occurrence of which is formed and disturbed with a muddy yellow liquid (pm).
The areas of defeat are mainly the open areas of the body, it is usually hands, legs, less often on the buttocks, face, etc. The attack of the fingers can be particularly dangerous, as basically they wave with her hand with the thought that herself will come out somehow, and in vain. The presence of a foreign body in the fingers can lead to the occurrence of Panaritis.
Foreign bodies need to be removed, and uluses should be subject to autopsy.
Removal Cannery does not seem to be a very complex procedure. It is necessary to disinfect the skin and the tool with alcohol, five percent iodine tincture.
If a poisonous foreign body fell into soft tissues, you must immediately consult a doctor. In addition, after any incident, the consequence of what was in the fabric of the foreign body, only a portion of foreign bodies located closer to the surface were often removed. The remnants of the bodies may not be completely removed, but in such cases it remains.
The diagnosis of foreign bodies (glass, wood) provides some difficulties, with the exception of X-ray-contrast bodies (metal). The removal of foreign bodies does not take much time. Difficulties may occur when the foreign bodies are removed in the areas of brushes, stop and buttocks. The doctor usually introduces anticipate serum and anatoksin. The operation produces anesthesia, and the foreign body is tested under the X-ray with metal needles, which are subordinated to the foreign body in two planes. Removal occurs by the method of "fishing hooks". The place of entering the hook and the zone of the release of it sting is anesthetically novocaine. The hook is stretched until the sting is on the surface, after which the sting is biled, and the hook is pulled out in the opposite direction.
Do not tighten with treatment, do not tolerate pain, do not bring the wound before the suppuration! The development of purulent wounds requires special attention and treatment, mainly to avoid blood infection (sepsis), which can cause anaerobic or aerobic bacteria.