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Czym jest zastrzał palca i dlaczego wymaga szybkiej reakcji?

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Zastrzał to ostre ropne zapalenie skóry, które najczęściej występuje na opuszce palca dłoni, rzadziej na stopie. Może powstać w wyniku nieprofesjonalnie wykonanego manicure’u czy obgryzania paznokci. Nieleczony stan zapalny palca grozi poważnymi powikłaniami – zniszczeniem paznokcia, upośledzeniem funkcji ręki, martwicą tkanek, a nawet uszkodzeniami ścięgien i stawów.

By pojawił się zastrzał, wystarczy drobny uraz palca, ukłucie, zadrapanie czy skaleczenie. Do uszkodzenia ciągłości skóry często dochodzi w wyniku zrywania skórek wokół paznokcia, ukłucia niesterylną igłą, wejścia drzazgi w palec czy podczas wykonywania prac ogrodowych. Przez uszkodzoną skórę do organizmu przedostają się bakterie, najczęściej paciorkowca i gronkowca złocistego, co prowadzi do ropnego zapalenia. Na zastrzały szczególnie narażone są osoby cierpiące na cukrzycę i zaburzenia odporności, dzieci oraz osoby starsze.

Czym się różni zastrzał od zanokcicy?

Zanokcica to bakteryjne zakażenie, które zwykle obejmuje wał górny paznokcia. Natomiast zastrzał najczęściej objawia się na wale bocznym paznokcia i opuszce palca. Jest też skutkiem zranienia głębszego niż w przypadku zanokcicy.

Jak rozwija się zastrzał palca?

Początkowo zastrzał obejmuje powierzchowną warstwę skóry. Objawia się zaczerwienieniem, uciepleniem i miejscowym obrzękiem. Pod zgrubiałym naskórkiem zaczyna gromadzić się ropa. Pulsujący ból palca nasila się zwłaszcza nocą.

Postępowanie stanu zapalnego w głąb tkanek prowadzi do zastrzału podskórnego. Jego symptomem jest wzmożona bolesność objętej zapaleniem powierzchni, szczególnie podczas nacisku oraz opuszczania kończyny.

Trzecim etapem rozwijającego zapalenia palca jest zastrzał ścięgnisty, do którego dochodzi, gdy zakażenie dotrze do pochewki ścięgnistej. Objawia się wzmożonym bólem ścięgien przy prostowaniu i przykurczaniu palca. U chorego może wystąpić podwyższona temperatura.

Kolejnymi i najniebezpieczniejszymi stadiami stanu zapalenia palca są zastrzał stawowy oraz kostny, który potwierdza się badaniem RTG. Stan zapalny obejmuje stawy, paliczki i kości. Ból wyraźnie się nasila, chory ma wysoką temperaturę i dreszcze. Może dojść do demineralizacji paliczka.

Jakie są powikłania nieleczonego zastrzału palca?

Nieleczony zastrzał palca powoduje upośledzenie funkcji ręki i może doprowadzić do zdeformowania lub całkowitego zniszczenia paznokcia. Postępujące w głąb tkanek zakażenie grozi posocznicą, zapaleniem powięzi i szpiku kostnego oraz uszkodzeniami skóry, tkanek, ścięgien, stawów i kości.

Jak wygląda leczenie zastrzału palca?

W przypadku zastrzału skórnego nie jest konieczna interwencja lekarza. Leczenie polega przede wszystkim na odkażaniu powierzchni, na której rozwinął się stan zapalny. Zaleca się stosowanie okładów łagodzących – wysoką skuteczność mają szałwia, rumian rzymski, roztwór sody oczyszczonej, babka lancetowata, nagietek lekarski czy rumianek. Dobrym rozwiązaniem jest również stosowanie maści ichtiolowej, która ma działanie obkurczające.

Jeśli jednak zastrzał rozwinie się w głębszych warstwach tkanek i wystąpi duży obrzęk, należy wdrożyć specjalistyczne leczenie. Lekarz wykonuje nacięcie boczne lub półkoliste objętego stanem zapalnym miejsca, co pozwala na uwolnienie ropy z rany. Następnie przeprowadza się drenaż ogniska zakażenia. W przypadku zastrzału stawowego oprócz tego należy wypłukać zajętą jamę stawową, przeprowadzić łyżeczkowanie obumarłych tkanek, a palec unieruchomić. Zapalenie kostne wymaga także usunięcia przetok, treści ropnej i tkanek martwiczych, martwiaków kostnych oraz zajętej zapaleniem kości. Po wykonanym zabiegu wdraża się antybiotykoterapię, a kończynę unieruchamia.

Źródło: „Chirurgia”, red. W. Noszczyk, t. 1, Warszawa 2005, str. 204-206.

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