Carbuncles: Causes, Symptoms, and Treatments

Carbuncles Causes

The name is derived from Latin: Carbunculus, a small coal.

• This is an infective gangrene of the subcutaneous tissue caused by Staphylococcus aureus. It commonly occurs in diabetic patients Patients with poor immunity or those undergoing radiotherapy may also develop carbuncle.
• Sites: Nape of the neck is the most common site, followed by the back and shoulder region. The skin of these sites is coarse and has poor vascularity.
• Carbuncle can also occur in kidneys.

Carbuncle Staphylococcal Infections of Surgical Importance

• Boil
• Carbuncle
• Breast abscess
• Parotitis
• Osteomyelitis

Carbuncle Pathology

• The initial lesion is similar to a boil in the form of a hair follicle infection with perifolliculitis. Since the majority of patients are diabetic, the infection takes a virulent course and results in subcutaneous fat necrosis, giving rise to multiple abscesses.
• These abscesses are intercommunicating and open to the exterior by multiple sieve-like openings. This appearance is described as cribriform appearance which is the pathognomonic of a carbuncle.

Read And Learn More: General Surgery Notes

Carbuncles Symptoms

Carbuncle Clinical Features

• Typically, the patient is a diabetic.
• Severe pain and swelling in the nape of the neck.
• Constitutional symptoms, such as fever with chills and rigours, are severe.
• The surface is red and angry-looking like red hot coal.
• The surrounding area is indurated.
• Later, skin over the centre of the carbuncle softens and peripheral satellite vesicles appear, which rupture and discharge pus, giving rise to a cribriform appearance.
• The end result is the development of a large crateriform ulcer with a central slough.

Carbuncle Complications

1. Worsening of diabetic status, resulting in diabetic ketoacidosis.
2. Extensive necrosis of the skin overlying the carbuncle. Hence, it is included under acute infective gangrene.
3. Septicaemia, toxaemia.

Carbuncle Treatment Summary of Carbuncle

• Caused by Cocci
• Abscesses Communicating
• Red hot like Coal
• Appearance Cribriform, Crateriform ulcer
• Gangrene Cutaneous (subcutaneous)
• Drug of choice Cloxacillin
• Diabetes Control
• Incision Cruciate

Control diabetes, preferably with injectable insulin.

• Appropriate parenteral antibiotics are given till complete resolution occurs. Most strains of Staphylococcus aureus are sensitive to cloxacillin, flucloxacillin, erythromycin, and some cephalosporins.
• However, methicillin-resistant Staphylococcus aureus (MRSA) bacteria are resistant to these drugs. They are sensitive only to the expensive drug vancomycin, which has to be given intravenously.
• Improve the general health of the patient.
• If the carbuncle does not show any softening or shows evidence of healing, it is not incised and may be left open to the exterior. Alternatively, saline dressings may be applied to reduce oedema. Complete resolution may take place within 10–15 days.
• Surgery is required when there is pus. A cruciate incision is preferred because of the multiple abscesses and extensive subcutaneous necrosis.
• Edges of the skin flap are excised, the pus is drained, loculi are broken down, the slough is excised, and the cavity is irrigated with antiseptic agents. Like a pyogenic abscess, a wound heals with granulation tissue from the depth.