– Pyomyositis is an infection of muscle almost always due to Staphylococcus aureus, preferentially affecting the muscles of the limbs and trunk. The locations are sometimes multiple.
– In the diffusion phase when the muscle is swollen, hot and painful, it is hoped that medical treatment can reduce infection. A collection phase, single-incision drainage is curative.
Treatment:
In the diffusion phase:
– Immobilise the limb.
– Antibiotic therapy as for other abscesses.
– Adapt analgesics to the pain level.
– Alcoholic dressing to promote the collection of the abscess compresses soaked in 70% alcohol, 2 times / day (up to 3 times / day maximum to avoid burning the skin).
A collection phase:
Treatment is incision-drainage muscle abscess, according to the rules of a classical incision abscess. By cons, muscular abscess is often deeper. Sometimes you have to locate, make an exploratory puncture aspiration syringe with a large bore needle, which should bring pus. The latter, although it reduces the pus can not suffice to treatment.
Equipment and anesthesia
The same as for an abscess.
Technique:
– Incision wide in the axis of the limb, over the abscess, respecting the neurovascular axes; incision of the skin, subcutaneous tissues and muscular fascia with a scalpel (Figure 11a).
– Dissect the muscle fibers in the non-toothed forceps (Kelly) or blunt scissors, driven closed in muscle and reassembled gently opening slightly (to be perpendicular to the fiber direction), until the purulent cavity (Figure 11b) .
– Exploration and drain pus finger with collapse of adhesions and néocavités (Figure 11c).
– Wash abundantly with antiseptic solution.
– Drainage from the incision with a big knife.
– The blade should be fixed by a stitch on one of the edges of the wound and removed around the 5th day (Figure 11d).
Particular location:
Psoas myositis: myositis when the seat on the right, the same clinical presentation as acute right iliac appendicitis.Evacuate to a surgical hospital.
