Abscess

This is a limited inflammation caused by the accumulation of pus in tissues, organs, or confined spaces in the body. It is usually accompanied by swelling in the area, pain, redness, elevated temperature at the site of pain, and difficulty moving the surrounding muscles. It may appear over the course of a few hours, a few days, or a week. It depends on the strength of the bacteria that caused it. The most rapid, simple, and effective treatment is surgery - cutting and draining. You do not need to take antibiotics. Still in force is the old Latin adage, “Ubi pus, ibi evacua,“ which means, “Where there is pus, let it out.” Under local anesthesia, the cavity is purged and a drain is attached to the wound and bandaged with sterile materials. The bandages will be changed a few times while the body copes with the process. A simple indicator of whether things are completed is how much residue there is on the dressing. When the wound is dry, the drain is removed and allowed to close autonomously. This usually occurs within a few days. If the drain is removed prematurely, the wound continues to secrete and it is possible that a fistula may form. This should be prevented because it entails a new operation. Usually, with good cooperation between the surgeon and the patient, patients fully recover within ten days.

Phlegmon

Phlegmon is a diffuse acute purulent inflammation of loose connective tissue under the skin. It is most commonly caused by group-A beta-hemolytic streptococci and Staphylococcus aureus. It develops in the subcutaneous adipose tissue and between fascial spaces. Phlegmons are aggressively treated surgically, since gentle treatment tends to expand and deepen the problem. Outpatient treatment is possible for small, limited phlegmons in the initial stages. The condition almost always requires additional oral antibiotic treatment. Larger and re-emerging phlegmons require hospitalization due to the need for frequent check-ups because of the possibility of rapid deepening.

The surgical treatment itself once again rests on the principle of the evacuation of the inflamed substrate, although sometimes it is not yet formed. Wide skin incisions that let in more oxygen solve the problem because most agents are dependent on it. Phlegmons usually develop in an environment without oxygen and its presence kills them. Therefore an old treatment - peroxide - is still irreplaceable today.

Pilonidal sinus

These cavities are thick pustule formations lined with a squamous epithelium layer. Most often it is a congenital cyst which can be filled with any byproducts of the skin and its appendages: sweat, fatty secretions, hair, or dead cells. It frequently occurs is in the cleft at the top of the buttocks, or within 5 to 6 cm of this area.  Usually, the skin above it is very porous, which provides runoff contents. When these pores become blocked and contaminated because of the high bacteria content of the area, inflammation is almost certain.

An operation is the only treatment for this condition. It is significantly easier and more successful before the most frequent complication appears: purulence. At this point complete removal of the sinus and restoration of healthy tissue is possible. In the case of a complication or abscess, we need to open the cavity through a small incision to evacuate and drain the pus. This enables the body's own tissues to fight off the infection. In progressive stages, we can revisit the possibility of radical removal of the cyst.

Ingrown nails

Ingrown nails are a problem that we often cause ourselves. They are a result of improper trimming of the nails: so short that they grow behind and below the area where the nail usually grows freely over the skin. Then, due to compression from shoes, they continue to grow in the wrong direction, into the toe tissue. This occurs only in toenails.

When this has happens, I believe there are two options: The first option is possible provided that the problem is recent. We can use certain procedures to over time to allow the nail to take its usual path and grow on top of the tissues of the toe. If, over time, the inflammatory changes in the surrounding tissues become advanced enough, it is not worth wasting time trying to solve the problem without surgery. In these cases, I recommend removing the entire fingernail immediately with curettage of infected tissue. This quickly stops the infection and allows sufficient time for the new nail to grow in a healthy environment. I do not recommend partial resection of the nail due to an uncertain final effect: Often, the problem cannot be solved or the results can be extremely unsatisfactory aesthetically. The nail remains permanently one-quarter of its previous size and unattractive, especially if the same operation is performed on the other side.

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