Results of the treatment of phlegmon of Streptococcus pyogenes aetiology within upper limbs

Andrzej Żyluk, Piotr Puchalski, Zbigniew Szlosser


Phlegmon is a purulent infection which spreads in loose connective tissue. It occurs most commonly in the limbs as a complication of other local infections. Untreated or inadequately treated infections in the skin of the fingers or hands are susceptible to phlegmon. In most cases, the infecting organism is Staphylococcus aureus. This article reports 7 cases of phlegmon involving upper limbs, caused by the Streptococcus pyogenes organism. The course of these types of infection are more serious, and the range of tissue damage greater, than those caused by staphylococci. This article presents the causes of the phlegmon, the methods and course of management, and the results of these. The principles of surgical management include wide incisions in the skin and an evacuation of pus and necrotic tissue debris. The skin is then sealed with stitches or a skin graft once the wound is clean. Of the 7 treated patients, 1 died in the intensive care unit due to sepsis and mutli-organ failure and 1 patient lost his all fingers due to necrosis. The authors believe that it is desirable that doctors working in emergency units and surgical admission rooms should be familiar with the basic rules of diagnosing and managing these potentially life-threatening or hand crippling disease


Streptococcus phlegmon; sepsis; tissue necrosis

Full Text:



Lee DH, Ferlic RJ, Neviaser RJ. Hand infections. In: Berger RA, Weiss AP, editors. Hand surgery. Philadelphia: Lippincott; 2004. p. 1777-803.

Żyluk A. Zakażenia w obrębie ręki. In: Żyluk A, editor. Chirurgia ręki. Warszawa: Medipage; 2017. p. 214-31.

Żyluk A, Puchalski P. Ciężkie zakażenia w obrębie kończyny górnej – analiza przyczyn i sposobów leczenia. Chir Narz Ruchu 2006;71(4):239-44.

Żyluk A, Piotuch B. Rozległa ropowica paciorkowcowa kończyny górnej po otarciu naskórka ręki, powikłana posocznicą – opis przypadku. Chir Narz Ruchu Ortop Pol 2015;80(6):207-13.

Hohendorff B, Seyler S, Naik M, Biber F, Franke J. Amputation of the hand due to necrotising fasciitis: a case report. Handchir Mikrochir Plast Chir 2015;47(1):62-6. doi: 10.1055/s-0034-1370957.

Edlich RF, Winters KL, Woodard CR, Britt LD, Long WB 3rd. Massive soft tissue infections: necrotizing fasciitis and purpura fulminans. J Long Term Eff Med Implants 2005;15(1):57-65.

Freyer CW, Peters M. Palpable purpura complicated by streptococcal toxic shock syndrome resulting in limb necrosis and amputation: a case of levamisole and cocaine coingestion. Pharmacotherapy 2012;32(2):e17-23.


Copyright (c) 2021 Andrzej Żyluk, Piotr Puchalski, Zbigniew Szlosser

License URL: