Necrosis is treated or. dry necrosis. Treatment of necrosis with black bread

By its nature, the disease in question has quite serious consequences, since the result of necrosis is the death of individual (sometimes very extensive) tissue sections. As a result, the organs and systems of the patient will not be able to function fully in the future. Often, necrosis is the cause of death: pathological cells grow very quickly, so you should immediately respond to the first symptoms of the disease.

Diagnosis of necrosis - how to determine the form and stage of the disease?

In its development, this disease goes through 3 stages:

• Prenecrosis.

At this stage, certain changes take place, but they are reversible.

• Tissue death.

The affected cells die.

• destructive changes.

Pathological tissues disintegrate.

To detect necrosis, which is superficial, there are no special problems: the doctor gets acquainted with the patient's complaints, conducts blood tests, and takes a sample of fluid from the wound surface. In some cases, if gas gangrene is suspected, an x-ray of the affected area (to confirm the presence of gases) may be ordered.

With necrosis of internal organs, the diagnostic procedure is more extensive, and may include:

• Ren tgenography.

Effective at 2, 3 stages of the disease. At the initial stage of the disease, even in the presence of pronounced manifestations, the disease may not be detected. With sequestration, the problems of diagnosing in the later stages may lie in the fact that this pathology will be combined with osteoporosis, which is endowed with similar symptoms.

• radioisotope scanning.

It is prescribed in cases where the previous diagnostic method was ineffective. For the implementation of this procedure, the patient is injected with a medical preparation, which includes a radioactive substance. A few hours later, zones of radioactivity are fixed in the patient's body. The area affected by necrosis, due to the lack of blood circulation in it, will be presented in the picture as a “cold” spot.

• Computed tomography.

It is used at all stages, with suspicion of bone necrosis. At an early stage in the development of this pathology, the diagnostician during CT should pay attention to the presence of cystic cavities filled with fluid. The presence of such formations, with the ineffectiveness of previous research methods; The patient's complaints will help determine the diagnosis.

• Magnetic resonance imaging.

Effective at any stage of the disease, painless, safe for the patient. Through this research method, it is possible to detect even minor errors that are associated with impaired blood circulation on the tissues of internal organs.

Methods for the treatment of necrosis

How is the operation for necrosis?

Surgical treatment for necrosis is not indicated in all cases: here everything will depend on the form of necrosis, its stage:

• Necrotomy.

It is used for wet necrosis (wet gangrene), which is localized in the region of the limbs, chest. Resection of pathological tissues is often performed without the use of anesthesia. The depth of the incision should reach healthy tissue until bleeding begins.

It is indicated for wet necrosis, within the framework of non-dead tissue. The signal for this manipulation is the appearance of a clear boundary that separates the healthy tissue from the pathological one.

After necretomy, dermatoplasty should be performed, or (if the defective tissue is not too large in volume) sutures should be applied.

• Amputation of the limb / resection of the affected organ. Required under the following circumstances:

1. The patient is diagnosed with wet necrosis (wet gangrene), which is rapidly progressing.
2. There is a dry necrosis that does not respond to conservative treatment, there are signs of its transition to wet necrosis.

When amputating a limb, resection is carried out significantly above the visible level of the lesion. The length of stay in the hospital after the amputation is completed can vary from 6 to 14 days. In the postoperative period, the patient should drink a course of antibiotics, painkillers. If there are no complications after the manipulation, it is permissible to carry out prosthetics after 2 weeks.

Amputation with necrosis is fraught with the following complications:

• Necrosis of the skin in the area of ​​the stump. Such a phenomenon can occur with inadequate blood supply to the tissues of the specified area.
• Angiotrophoneurosis. The consequence of a violation of the integrity of the nerves during the manipulation. In the future, the operated patient will complain of pain in the scar area.
• Phantom pain. For some time after the operation, the patient may "ache", "itch" the amputated limb.
• Keloid scars. They are postoperative scars of considerable size. Their formation is associated with the predisposition of the operated person to such phenomena.

With necrosis that affects bone tissue, several types of surgical procedures can be used:

Endoprosthetics

It provides for the replacement of the affected joint with an artificial one. The implant must be made of durable materials (titanium, zirconium). Fixation of the pin is carried out by means of cement / glue. Endoprosthetics is a common operation for bone lesions among patients over 50 years of age. The procedure under consideration is rather complicated to perform. Among the postoperative complications, the most popular are: infection, loosely fixed prosthesis (needs a second operation).

Arthrodesis

This manipulation consists in resection of the bones that articulate with each other. After that, these bones are connected, thereby ensuring their fusion in the future. This procedure is fraught with negative consequences in terms of the ability to work of the operated person: it is problematic to climb / descend the stairs, sit.

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Content

All important processes in the human body occur at the cellular level. Tissues, as a collection of cells, perform protective, supporting, regulatory and other significant functions. When cell metabolism is disturbed due to various reasons, destructive reactions occur that can lead to changes in the functioning of the body and even cell death. Skin necrosis is a consequence of pathological changes and can cause irreversible deadly phenomena.

What is tissue necrosis

In the human body, tissue, represented by a combination of structural and functional elementary cells and extracellular tissue structures, is involved in many vital processes. All types (epithelial, connective, nervous and muscular) interact with each other, ensuring the normal functioning of the body. The natural death of cells is an integral part of the physiological mechanism of regeneration, but the pathological processes that occur in cells and the extracellular matrix entail life-threatening changes.

The most severe consequences for living organisms are characterized by tissue necrosis - cell death under the influence of exogenous or endogenous factors. In this pathological process, swelling and a change in the native conformation of cytoplasmic protein molecules occur, which leads to the loss of their biological function. The result of necrosis is the adhesion of protein particles (flocculation) and the final destruction of the vital permanent components of the cell.

The reasons

The cessation of the vital activity of cells occurs under the influence of changed external conditions for the existence of the organism or as a result of pathological processes occurring inside it. The causative factors of necrosis are classified in terms of their exogenous and endogenous nature. Endogenous reasons why tissues can die include:

• vascular- violations in the work of the cardiovascular system, which led to a violation of the blood supply to tissues, deterioration of blood circulation;
• trophic- a change in the mechanism of cellular nutrition, a violation of the process of ensuring the safety of the structure and functionality of cells (for example, skin necrosis after surgery, long-term non-healing ulcers);
• metabolic- a violation of metabolic processes due to the absence or insufficient production of certain enzymes, a change in the general metabolism;
• allergic- a high-intensity reaction of the body to conditionally safe substances, which results in irreversible intracellular processes.

Exogenous pathogenic factors are caused by the impact on the body of external causes, such as:

• mechanical- damage to the integrity of tissues (wound, trauma);
• physical– violation of functionality due to the impact of physical phenomena (electric current, radiation, ionizing radiation, very high or low temperature – frostbite, burns);
• chemical- Irritation by chemical compounds;
• toxic- defeat by acids, alkalis, salts of heavy metals, drugs;
• biological- destruction of cells under the influence of pathogenic microorganisms (bacteria, viruses, fungi) and the toxins they secrete.

signs

The onset of necrotic processes is characterized by loss of sensation in the affected area, numbness of the extremities, and a tingling sensation. The pallor of the skin indicates a deterioration in blood trophism. The cessation of the blood supply to the damaged organ leads to the fact that the skin color becomes cyanotic, and then acquires a dark green or black tint. General intoxication of the body is manifested in the deterioration of health, fatigue, exhaustion of the nervous system. The main symptoms of necrosis are:

• loss of sensitivity;
• numbness;
• convulsions;
• puffiness;
• hyperemia of the skin;
• sensation of coldness in the extremities;
• violation of the functioning of the respiratory system (shortness of breath, changes in the rhythm of breathing);
• increased heart rate;
• permanent increase in body temperature.

Microscopic signs of necrosis

The branch of histology devoted to the microscopic examination of diseased tissues is called pathohistology. Specialists in this field examine sections of organs for signs of necrotic damage. The necrosis is characterized by the following changes occurring in the cells and interstitial fluid:

• loss of the ability of cells to selectively stain;
• core transformation;
• discomplexation of cells as a result of changes in the properties of the cytoplasm;
• dissolution, disintegration of an intermediate substance.

The loss of the ability of cells to stain selectively, under a microscope, looks like a pale structureless mass, without a clearly defined nucleus. The transformation of the nuclei of cells that have undergone necrotic changes develops in the following directions:

• karyopyknosis- wrinkling of the cell nucleus, which occurs as a result of the activation of acid hydrolases and an increase in the concentration of chromatin (the main substance of the cell nucleus);
• hyperchromatosis- there is a redistribution of chromatin clumps and their alignment along the inner shell of the nucleus;
• karyorrhexis– complete rupture of the nucleus, dark blue clumps of chromatin are arranged in random order;
• karyolysis- violation of the chromatin structure of the nucleus, its dissolution;
• vacuolization- vesicles containing a clear liquid form in the cell nucleus.

The morphology of leukocytes has a high prognostic value in skin necrosis of infectious origin, for the study of which microscopic studies of the cytoplasm of the affected cells are carried out. Signs characterizing necrotic processes can be the following changes in the cytoplasm:

• plasmolysis- melting of the cytoplasm;
• plasmorhexis- the disintegration of the contents of the cell into protein clumps, when poured with xanthene dye, the studied fragment turns pink;
• plasmopyknosis- wrinkling of the internal cellular environment;
• hyalinization- compaction of the cytoplasm, its acquisition of uniformity, vitreousness;
• plasma coagulation- as a result of denaturation and coagulation, the rigid structure of protein molecules breaks down and their natural properties are lost.

Connective tissue (intermediate substance) as a result of necrotic processes undergoes gradual dissolution, liquefaction and decay. The changes observed in histological studies occur in the following order:

• mucoid swelling of collagen fibers- the fibrillar structure is erased due to the accumulation of acid mucopolysaccharides, which leads to a violation of the permeability of vascular tissue structures;
• fibrinoid swelling- complete loss of fibrillar striation, atrophy of cells of the interstitial substance;
• fibrinoid necrosis- splitting of the reticular and elastic fibers of the matrix, the development of structureless connective tissue.

Types of necrosis

To determine the nature of pathological changes and the appointment of appropriate treatment, it becomes necessary to classify necrosis according to several criteria. The classification is based on clinical, morphological and etiological features. In histology, several clinical and morphological varieties of necrosis are distinguished, the belonging of which to one or another group is determined based on the causes and conditions for the development of the pathology and the structural features of the tissue in which it develops:

• coagulation(dry) - develops in protein-rich structures (liver, kidneys, spleen), is characterized by processes of compaction, dehydration, this type includes Zenker (waxy), adipose tissue necrosis, fibrinoid and caseous (curd-like);
• colliquative(wet) - development occurs in tissues rich in moisture (brain), which undergo liquefaction due to autolytic decay;
• gangrene- develops in tissues that are in contact with the external environment, there are 3 subspecies - dry, wet, gas (depending on the location);
• sequestration- represents a site of a dead structure (usually a bone structure) that has not undergone self-dissolution (autolysis);
• heart attack- develops as a result of an unforeseen complete or partial violation of the blood supply to the organ;
• bedsores- is formed with local circulatory disorders due to constant compression.

Depending on the origin of necrotic tissue changes, the causes and conditions for their development, necrosis is classified into:

• traumatic(primary and secondary) - develops under the direct influence of a pathogenic agent, according to the mechanism of occurrence, it refers to direct necrosis;
• toxigenic- occurs as a result of the influence of toxins of various origins;
• trophoneurotic- the cause of development is a violation of the central or peripheral nervous system, causing violations of the innervation of the skin or organs;
• ischemic- occurs with insufficiency of peripheral circulation, the cause may be thrombosis, blockage of blood vessels, low oxygen content;
• allergic- appears as a result of a specific reaction of the body to external stimuli, according to the mechanism of occurrence, it refers to indirect necrosis.

Exodus

The significance of the consequences of tissue necrosis for the body is determined based on the functional characteristics of the dying parts. Necrosis of the heart muscle can lead to the most severe complications. Regardless of the type of damage, the necrotic focus is a source of intoxication, to which the organs react by developing an inflammatory process (sequestration) in order to protect healthy areas from the harmful effects of toxins. The absence of a protective reaction indicates an oppressed reactivity of the immune system or a high virulence of the causative agent of necrosis.

An unfavorable outcome is characterized by purulent fusion of damaged cells, a complication of which is sepsis and bleeding. Necrotic changes in vital organs (cortical layer of the kidneys, pancreas, spleen, brain) can be fatal. With a favorable outcome, the dead cells melt under the influence of enzymes and the dead areas are replaced with an interstitial substance, which can occur in the following directions:

• organization- the place of necrotic tissue is replaced by connective tissue with the formation of scars;
• ossification- the dead area is replaced by bone tissue;
• encapsulation- a connecting capsule is formed around the necrotic focus;
• mutilation- the outer parts of the body are rejected, self-amputation of dead areas occurs;
• petrification- calcification of areas subjected to necrosis (replacement with calcium salts).

Diagnostics

It is not difficult for a histologist to identify necrotic changes of a superficial nature. To confirm the diagnosis, established on the basis of an oral questioning of the patient and a visual examination, testing of blood and a sample of fluid from the damaged surface will be required. If there is suspicion of the formation of gases with diagnosed gangrene, an x-ray will be prescribed. The necrosis of tissues of internal organs requires a more thorough and extensive diagnosis, which includes methods such as:

• X-ray examination- is used as a method of differential diagnosis to exclude the possibility of other diseases with similar symptoms, the method is effective in the early stages of the disease;
• radioisotope scanning- shown in the absence of convincing X-ray results, the essence of the procedure is the introduction of a special solution containing radioactive substances, which are clearly visible in the image during the scan, while the affected tissues, due to impaired blood circulation, will be clearly distinguished;
• CT scan- it is carried out with suspicion of bone tissue death, during the diagnosis, cystic cavities are detected, the presence of fluid in which indicates pathology;
• Magnetic resonance imaging is a highly effective and safe method for diagnosing all stages and forms of necrosis, with the help of which even minor cell changes are detected.

Treatment

When prescribing therapeutic measures for diagnosed tissue death, a number of important points are taken into account, such as the form and type of the disease, the stage of necrosis and the presence of concomitant diseases. The general treatment of soft tissue skin necrosis involves the use of pharmacological drugs to maintain the body depleted by the disease and strengthen the immune system. For this purpose, the following types of drugs are prescribed:

• antibacterial agents;
• sorbents;
• enzyme preparations;
• diuretics;
• vitamin complexes;
• vasodilators.

Specific treatment of superficial necrotic lesions depends on the form of pathology:

With the localization of necrotic lesions in the internal organs, treatment consists in applying a wide range of measures to minimize pain symptoms and preserve the integrity of vital organs. The complex of therapeutic measures includes:

• drug therapy - taking non-steroidal anti-inflammatory drugs, vasodilators, chondroprotectors, drugs that help restore bone tissue (vitamin D, calcitonitis);
• hirudotherapy (treatment with medicinal leeches);
• manual therapy (according to indications);
• therapeutic physical exercises;
• physiotherapeutic procedures (laser therapy, mud therapy, ozokerite therapy);
• surgical methods of treatment.

Surgical intervention

Surgical impact on the affected surfaces is used only if the conservative treatment is ineffective. The decision on the need for an operation should be made immediately if there are no positive results of the measures taken for more than 2 days. Delay without good reason can lead to life-threatening complications. Depending on the stage and type of the disease, one of the following procedures is prescribed:

Preventive measures

Knowing the fundamental risk factors for the occurrence of necrotic processes, preventive measures should be taken to prevent the development of pathology. Along with the recommended measures, it is necessary to regularly diagnose the state of organs and systems, and if suspicious signs are found, seek advice from a specialist. Prevention of pathological cellular changes is:

• reducing the risk of injury;
• strengthening the vascular system;
• increase the body's defenses;
• timely treatment of infectious diseases, acute respiratory viral infection (ARVI), chronic diseases.

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Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

Discuss

Tissue necrosis: types and treatment

Necrosis is the cessation of the vital activity of cells, organs or tissues, which does not have a reverse effect. That is, in other words, there is a disintegration of the tissues of a still functioning human organism or animal. Unfortunately, in our modern world, this phenomenon is quite common.

The reasons

Why do entire sections begin to die off in a living organism, and what are the prerequisites for the development of such processes? In general terms, gangrene begins in those places where blood circulation is disturbed. There are the following causes of necrosis:

The death of individual areas may appear as a result of the development of certain diseases. For example, the cause of this pathology is often diabetes mellitus. In addition, the occurrence of gangrene may be due to damage to large nerves or the spinal cord.

Types of disease

Depending on the mechanism of occurrence, pathology is classified into the following types:

Also, experts distinguish two more types of necrosis.

Colliquation (wet) necrosis

Along with the necrosis of the areas, their edema is observed.

Coagulative (dry) necrosis

The necrosis of tissues is accompanied by their complete dehydration. The disease most often develops in areas rich in proteins, but depleted in fluids. For example, pathology can affect the cells of the liver, spleen or adrenal glands, where poor blood circulation and oxygen deficiency are most often noted.

Varieties of coagulative necrosis

There are the following types of dry necrosis:

Symptoms

The disease may be accompanied by the following symptoms:

Stages of the disease

The course of the disease takes place in several stages, of which the following stand out:

Diagnostics

Unfortunately, at the initial stage, necrosis is almost impossible to detect. X-ray examination can show the presence of pathology only at 2-3 stages of pathology development. To date, only computed tomography and magnetic resonance imaging devices and allow you to identify the changes in the tissues that have begun, which allows you to start solving the problem in time.

Consequences of the disease

If adequate and timely treatment is not carried out, the consequences of necrosis may be as follows:

Treatment of soft tissue skin necrosis

Treatment of pathology is determined by such factors as the causes of the development of the disease, its type, the degree of tissue damage. It is very important to identify the disease at the initial stages and start treatment as soon as possible, otherwise serious complications may occur, including death.

bedsores

Bedsores occur due to poor patient care. In such cases, the following actions should be taken:

Dry necrosis

Treatment is carried out in two stages.

The first is drying tissues and taking measures to prevent the further development of the disease. The skin around the affected area is treated with an antiseptic. Then a bandage is applied to the focus of inflammation, previously moistened with boric acid, Chlorhexidine or ethyl alcohol. The area affected by necrosis must be dried. To do this, use the usual brilliant green or a solution of manganese (5%).

At the next stage, excision of atrophied tissues is carried out.

Before starting the treatment of necrosis, it is necessary to get rid of the cause that caused it, then take measures aimed at restoring blood circulation in the affected areas. In addition, the patient is prescribed antibiotic therapy in order to avoid infection of the soft tissues with a bacterial infection that can lead to death.

Wet necrosis

Treatment of wet necrosis soft tissues or skin is determined by the degree of damage to diseased areas. At the initial stages, specialists try to convert wet necrosis into a dry form. If their actions did not bring the desired results, a decision is made on surgical intervention.

Local treatment of wet necrosis

For this, the following actions are carried out:

General treatment of wet necrosis

Wet skin necrosis after surgery or in other cases are treated with the following methods:

• vascular therapy. Specialists take measures to restore the blood supply to the affected tissues.
• Antibacterial therapy. The patient is given antibiotics through a vein or artery.
• Detoxification therapy. It is produced in order to prevent infection of living areas of soft tissues located near the lesions.

Surgery

In the absence of the effect of the drug therapy performed, an operation is prescribed. In such a situation, this is the only chance to save the life of the patient. Surgical treatment includes the following steps:

Folk remedies

Necrosis is a rather serious disease, therefore, at the slightest suspicion, it is necessary to urgently consult a doctor. In the absence of such an opportunity, you can try to provide the patient with first aid using traditional medicine.

But at the first opportunity, the patient must be taken to the hospital!

Bedsores can be dealt with in the following ways:

Soft tissue necrosis, whatever it is caused, is a rather serious and dangerous disease, which, if not properly treated, can result in the death of the patient. Therefore, you should not hope that everything will go away by itself, like a runny nose, or you can get rid of necrosis on your own. The very first signs of pathology should serve as a signal to contact a specialist, otherwise the consequences can be very sad.

Attention, only TODAY!

Depending on the type of necrosis, a certain type of treatment is prescribed. Necrosis of a coagulative or dry type is formed in a certain element of the body or in an organ, while not spreading to other parts of the body. With dry necrosis, dead tissues are slowly dried. Thus, a demarcation line arises that separates healthy tissues from infected ones.
There are cases when necrotic tissue decreases in size. This process is called mummification.

Symptoms

The main symptoms are as follows:

• the occurrence of pain in the affected area associated with a decrease in blood supply in this area (ischemia);
• pale skin color (soon marbled);
• the affected area becomes cold;
• the pulse is out of the norm;
• there is no sensitivity;
• numbness.

In this case, there is prolonged pain in the limbs. In most cases, spasm occurs in the collateral arterial pathways.

The path of spread of necrosis begins with the peripheral nervous system in the limbs, and ends with the level of occlusion of the vessel.

First of all, it is necessary to take measures to prevent the occurrence of infections in the affected area. For this, special liquids are used, which are injected inside. Thus, the risk of infection is reduced.
Often this type of necrosis does not cause a fatal outcome or serious consequences for the body, since small amounts of tissue die when affected.

Development occurs in people whose immunity is most stable. Tissues that have large volumes of proteins and a minimum of fluid are more susceptible to occurrence. Necrosis passes without pathogens and is not related to diseases of another kind.
The cause of the disease is associated with improper blood circulation in a certain tissue area. As a consequence, necrosis due to inadequate circulation and minimal oxygen in the body can affect other organs, including the kidneys, adrenal glands, spleen, and heart muscle (myocardium).
Depending on the disease, necrosis affects different parts of the body:

• atherosclerosis and arterial thrombosis - limbs;
• burns and frostbite, Raynaud's disease - tissue in the area of ​​\u200b\u200bthe fingers;
• typhus of a typhus type - integuments.

Necrosis appears as a result of problems with blood circulation in a certain area. In tuberculosis and Sape disease, a subtype of coagulation necrosis progresses - caseous.
With dry necrosis, lifeless cells do not immediately lose their appearance, they can retain their shape for several days. At the same time, the core disappears immediately.
Examining such cells under a microscope, one can see only a pink, jelly-like mass of cytoplasm. Cytoplasmic proteins, due to their folding, receive a certain resistance to the action of lysosomal-type enzymes.

This type of necrosis got its name due to the dryness and density of dead areas, due to dehydration.

Varieties of dry necrosis

In medicine, several varieties of dry necrosis are known:

• ischemic - the most common;
• Zenkerovsky - often occurring in the thigh and muscles of the anterior abdominal wall;
• caseous - appearing with tuberculosis, syphilis, lymphogranulomatosis;
• fibrinoid - occurring in connective tissues.

Treatment of dry necrosis

There are two ways to stop the destruction of cells in tissues:

• surgical intervention;
• apply local treatment.

Local treatment, the most benign, consists in the application of the following measures: treatment of the area around the affected area with an antiseptic; applying a bandage soaked in ethyl alcohol or another disinfectant (boric acid, chlorhexidine), etc. But it is not always possible to do without the intervention of surgeons, since necrosis is a rather complex disease.
Therapy of a conservative type will be able to establish blood circulation in the affected area (inthymothrombectomy, shunting)
Self-treatment of this disease is not recommended. It is best to contact a specialist who will prescribe treatment.
The process of stopping the necrosis of tissue cells is quite complicated. Radical measures must be taken to restore the body. In such cases, the work is carried out by several doctors specializing in different fields of medicine.
The results of treatment may depend on several factors, including the site of the lesion, the size of the area with necrosis, and the general condition of the patient.
The destruction of tissues can have a toxic effect on the patient's body, due to the emergence of microbes in the affected area. That is why the first actions are aimed at disinfecting this area.
Experts recommend visiting doctors as often as possible in order to check the condition of your body. Such procedures can help identify the disease at the primary stage, which will greatly facilitate further treatment.

Necrosis is an irreversible process of necrosis of the affected tissues of a living organism as a result of external or internal factors. Such a pathological condition is extremely dangerous for a person, fraught with the most serious consequences and requires treatment under the supervision of highly qualified specialists.

Causes of necrosis

Most often lead to the development of necrosis:

• injury, injury, exposure to low or high temperature, radiation;
• exposure to the body of allergens from the external environment or autoimmune antibodies;
• impaired blood flow to tissues or organs;
• pathogenic microorganisms;
• exposure to toxins and certain chemicals;
• non-healing ulcers and bedsores due to impaired innervation and microcirculation.

Classification

There are several classifications of necrotic processes. According to the mechanism of occurrence, the following forms of tissue necrosis are distinguished:

1. Direct (toxic, traumatic).
2. Indirect (ischemic, allergic, trophoneurotic).

1. Colliquation necrosis (necrotic tissue changes are accompanied by edema).
2. Coagulative necrosis (complete dehydration of dead tissue). This group includes the following types of necrosis:
   • caseous necrosis;
   • Zenker's necrosis;
   • fibrinoid necrosis of connective tissue;
   • fat necrosis.
3. Gangrene.
4. Sequester.
5. Heart attack.

Symptoms of the disease

The main symptom of the pathology is the lack of sensitivity in the affected area. With superficial necrosis, the color of the skin changes - at first the skin turns pale, then a bluish tint appears, which can change to green or black.

If the lower extremities are affected, the patient may complain of lameness, convulsions, and trophic ulcers. Necrotic changes in the internal organs lead to a deterioration in the general condition of the patient, the functioning of individual body systems (CNS, digestive, respiratory, etc.)

With colliquation necrosis in the affected area, the process of autolysis is observed - decomposition of tissues under the action of substances secreted by dead cells. As a result of this process, capsules or cysts filled with pus are formed. The most characteristic picture of wet necrosis for tissues rich in fluid. An example of colliquative necrosis is an ischemic stroke of the brain. Diseases accompanied by immunodeficiency (oncological diseases, diabetes mellitus) are considered predisposing factors for the development of the disease.

Coagulative necrosis, as a rule, occurs in tissues that are poor in fluid, but contain a significant amount of protein (liver, adrenal glands, etc.). The affected tissues gradually dry out, decreasing in volume.

• With tuberculosis, syphilis, and some other infectious diseases, necrotic processes are characteristic of internal organs, the affected parts begin to crumble (caseous necrosis).
• With Zenker's necrosis, the skeletal muscles of the abdomen or thighs are affected, the pathological process is usually triggered by pathogens of typhoid or typhus.
• With fat necrosis, irreversible changes in fatty tissue occur as a result of injury or exposure to enzymes of damaged glands (for example, in acute pancreatitis).

Gangrene can affect both individual parts of the body (upper and lower limbs) and internal organs. The main condition is the obligatory connection, direct or indirect, with the external environment. Therefore, gangrenous necrosis affects only those organs that, through the anatomical channels, have access to air. The black color of dead tissues is due to the formation of a chemical compound of iron, hemoglobin and hydrogen sulfide of the environment.

There are several types of gangrene:

• Dry gangrene - mummification of affected tissues, most often develops in the limbs due to frostbite, burns, trophic disorders in diabetes mellitus or atherosclerosis.
• Wet gangrene usually affects the internal organs when infected tissues are infected, has signs of colliquat necrosis.
• Gas gangrene occurs when necrotic tissue is damaged by anaerobic microorganisms. The process is accompanied by the release of gas bubbles, which is felt on palpation of the affected area (symptom of crepitus).

Sequestration most often develops in osteomyelitis, is a fragment of dead tissue, freely located among living tissues.

A heart attack occurs due to a violation of blood circulation in a tissue or organ. The most common forms of the disease are myocardial and cerebral infarction. It differs from other types of necrosis in that necrotic tissues in this pathology are gradually replaced by connective tissue, forming a scar.

Outcome of the disease

In a favorable case for the patient, the necrotic tissue is replaced with bone or connective tissue, and a capsule is formed that limits the affected area. Extremely dangerous necrosis of vital organs (kidneys, pancreas, myocardium, brain), they often lead to death. The prognosis is also unfavorable for purulent fusion of the focus of necrosis, leading to sepsis.

Diagnostics

If there is a suspicion of necrosis of internal organs, the following types of instrumental examination are prescribed:

• CT scan;
• Magnetic resonance imaging;
• radiography;
• radioisotope scanning.

Using these methods, you can determine the exact location and size of the affected area, identify characteristic changes in the structure of tissues to establish an accurate diagnosis, form and stage of the disease.

Superficial necrosis, such as gangrene of the lower extremities, is not difficult to diagnose. The development of this form of the disease can be assumed on the basis of the patient's complaints, cyanotic or black color of the affected area of ​​the body, lack of sensitivity.

Treatment of necrosis

With necrotic changes in tissues, hospitalization in a hospital for further treatment is mandatory. For a successful outcome of the disease, it is necessary to correctly establish its cause and take timely measures to eliminate it.

In most cases, drug therapy is prescribed, aimed at restoring blood flow to the affected tissues or organ, if necessary, antibiotics are administered, and detoxification therapy is performed. Sometimes it is possible to help the patient only by surgery, by amputating part of the limbs or excising dead tissues.

In the case of skin necrosis, traditional medicine can be used quite successfully. In this case, baths from a decoction of chestnut fruits, ointment from lard, slaked lime and oak bark ash are effective.

The cause of tissue necrosis is a malnutrition of a certain tissue area due to trauma or its putrefactive inflammation, and more often the combined effect of both. This happens due to the impact on the cells of mechanical force (ruptures, compression), as well as due to developing infection and high or low temperatures.

Any tissues and organs can become necrotic. The speed and extent of the spread of necrosis is influenced by the ongoing mechanical impact, the addition of infection, as well as the features of the anatomical and physiological structure of the damaged organ.

To begin the manifestation of the development of necrosis, severe pain is characteristic, the skin becomes pale and cold and takes on a marble appearance. There is numbness and sensitivity is lost, the function is disturbed, although its manifestations are possible for some time after ascertaining necrosis. The necrosis begins from the lower sections and gradually spreads to the level of malnutrition, and then a line called "demarcation" is determined on the border of dead and living tissues. The presence of demarcation indicates the possibility of performing an operation - removing the necrotic part along this line or above it. This long-established rule of tactics among surgeons is the only correct one that meets today's ideas.

Therapeutic measures are aimed at maintaining the general condition using active infusion therapy (blood, blood substitutes, antibiotics, vitamins, etc.).

Local treatment consists in removing necrosis within healthy tissues, and the amount of surgical intervention depends on the type of gangrene, which is dry and wet. Dry proceeds favorably, and surgical intervention is indicated when a demarcation line is formed. With wet gangrene, when general manifestations are pronounced, accompanied by severe intoxication, an immediate amputation of the limb is carried out within healthy tissues, that is, above the level of the necrosis border.

It is known that more differentiated tissues are affected much earlier. Therefore, with necrosis of the muscles and skin, the tendons and bones are in a relatively unaffected state. During surgical intervention, it is necessary to take into account this phenomenon and not to remove necrotic areas to the full depth, but to excise only the affected ones (do not excise the bone tissue regardless of the state of viability) with replacement with a full-fledged skin-subcutaneous pedicled flap. Purulent complications should be eliminated by regional infusion of antibiotics.

When unaffected bones and tendons are identified, they are closed with plastic material according to one of the existing methods. In such cases, it is possible to save the segment of the limb and prevent the disability of the victim. There were 11 such patients.

All of them were operated on according to the technique adopted by us, which consisted in catheterization of the main vessel, removal of necrotic soft tissues with replacement of the soft tissue defect with a pedicle flap.

5 of them had damage to the lower leg, two to the foot, one to the forearm, and three to necrosis of the hand.

All patients had a very severe injury with damage to soft tissues and bones, in 2 patients with a closed fracture of the tibia, as a result of improper treatment (a circular plaster bandage was applied), necrosis of the tibia occurred, which required necrectomy of the segment.

One patient admitted 3 days after the injury of the forearm had signs of segment necrosis at the level of the fracture. Another patient has necrosis of the calcaneus and talus, which were removed during the treatment.

Three patients had an open fracture of the lower third of the leg bones with an acute purulent complication and necrosis of the tibia within 10-15 cm.

One patient, whose hand was under pressure, developed soft tissue necrosis of the hand and other injuries. All patients required a non-standard approach to rehabilitation treatment.

Since the degree of damage and affection of the patients under consideration is very diverse, and systematization is difficult, as an illustration, we will give several different types of lesions.

An example would be patient B., aged 26.

While working on the press, the right hand fell under it. The patient was taken to the surgical department of the regional hospital.

It was necessary to take into account the mechanism of formation of a wound around the hand, caused by compression by the press and arising along the edge of its impact. It could be assumed that the soft tissues were so affected that it was impossible to count on their recovery after exposure to a two-ton press. The resulting wound at the level of the wrist joint from the back surface and along the upper groove on the palmar side was sutured tightly, a plaster splint was applied.

Within a few days, the phenomena of necrosis of the damaged area of ​​the hand and signs of severe intoxication were clearly indicated.

She was admitted to the regional hospital from the Central District Hospital, where the amputation of the hand and the formation of a stump were proposed, in a serious condition. The right hand on the rear from the level of the wrist joint, on the palmar surface from the upper palmar groove - necrotic. In the indicated area, the skin is black, hard in places, all types of sensitivity are absent, there is profuse purulent discharge from under the scab and from the wound. When the scab is cut, there is no bleeding, but copious fetid pus is released. The function of the brush is completely broken. Radiography - no bone changes, sowing detritus on the flora and sensitivity to antibiotics.

Diagnosis: severe injury with crushing and necrosis of part of the hand and 2nd, 3rd, 4th, 5th fingers of the right hand.

Operated. The brachial artery was catheterized through a.Collateralis ulnaris superior and infusion of penicillin 20 million units was started. in the infusate.

A day later, rather loosely, in the form of a “glove”, necrotic soft tissues of the hand and fingers were removed. Excised necrotic, already darkened ends of the distal phalanges (Fig. 1).

The tendons of the deep flexors and extensors are sutured over the butt of the treated phalanges.

After excision of necrotic tissues and dressing of the wound of the hand, a skin-subcutaneous-fascial flap was cut out in the area of ​​the chest and abdomen according to the size of the defect of the hand and fingers, which were placed in this flap (Fig. 2).

Four weeks after the operation, the pedicle of the transplanted flap was cut off. Hand after cutting off the feeding leg. After wound healing, the patient was discharged home.

The infusion of antibiotics into the artery continued for 40 days with breaks between surgical interventions for two weeks. Two months after the healing of the wounds, the second finger was formed, and after the healing of the wounds, the patient was discharged and started to work (Fig. 4, 5).

Thus, our tactics with the use of plastic techniques under the guise of a long-term regional administration of antibiotics made it possible to preserve the function of the hand to a certain extent and, most importantly, prevent the disability of a still young woman.

In all patients, the engraftment of the flap occurred, in some with phenomena of marginal necrosis, followed by wound healing on its own, or with the addition of a split skin flap.

A complex subgroup of patients with tissue necrosis were patients with necrosis of more deeply located bone tissue.

The previous experience gained in the treatment of patients with soft tissue necrosis made it possible to reconsider the attitude towards the separation of the necrotic part of the limb, that is, not to carry out its amputation.

heart attack

Ischemic necrosis is the most common form, it becomes a consequence of ischemia. It is formed in the heart muscle, lungs, kidneys, spleen, brain, intestine, etc. Distribution options: the entire organ, part of the organ, can only be seen with a microscope (microinfarction).

Sequester

A sequester is an affected area with pus, located among healthy skin, more often a bone fragment is damaged in osteomyelitis, but may be lung tissue, muscles or tendons.

Hemorrhagic pancreatic necrosis

This is a severe pathology of the pancreas. It develops in the acute stage of pancreatitis or in chronic inflammation of the organ. It is manifested by severe pain in the region of the left rib, can be given to the lower back, chest, shoulder. There is nausea, tachycardia, temperature, red-blue spots form on the sides. With symptoms of pancreatic necrosis, the patient is brought by ambulance to a medical facility.

Diagnosis and treatment of skin necrosis

Superficial necrosis is diagnosed based on the patient's complaints, blood and fluid tests from the affected area.

To recognize the pathology of internal organs appoint:

• x-ray;
• radioisotope scanning;
• computed and magnetic resonance imaging.

When choosing a treatment, doctors take into account the type, form of the disease, stage, as well as the presence of other diseases. Treatment of the skin is carried out under the supervision of an infectious disease specialist, resuscitator and surgeon.

Apply intravenous therapy with penicillin, clindomycin, gentamicin. Appropriate antibiotics are selected according to microbiological data. Conduct infusion therapy and stabilize hemodynamics. The affected parts of the skin are removed surgically.

Treatment of aseptic necrosis of the femoral head

With the destruction of the bone mass, medical and surgical treatment is carried out. Aseptic necrosis of the head of the hip joint requires bed rest and walking with a cane so as not to burden the affected area.

In the treatment used:

1. Vascular drugs (Curantil, Trental, Dipyridamole, etc.)
2. Calcium metabolism regulators (Ksidifon, Fosamax)
3. Calcium with vitamin D and mineral preparations (Vitrum, Osteogenon, Aalfacalcidol)
4. Chondoprotectors (Artra, Don, Elbona)
5. Non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac, Naklofen)
6. Muscle relaxants (Mydocalm, Sidralud)
7. B vitamins

Necrosis can also take the form of sequestration, when dead parts of the bone tissue are localized inside the sequester cavity and separated from healthy tissues due to the course of a purulent process, with a disease such as osteomyelitis.

Bedsores are also a type of necrosis. They appear in immobilized patients as a result of prolonged tissue compression or damage to the integrity of the epidermis. In this case, the formation of deep and purulent ulcerative lesions is observed.

What to do to defeat tissue necrosis? Treatment

Therapy of necrosis depends on their type. If the lesion is dry, then the tissues are treated with antiseptics, and dressings based on chlorhexidine or ethyl alcohol are applied to the place of death. The necrosis zone is dried with a five percent solution of potassium permanganate or ordinary brilliant green. Next, the affected non-viable tissues are excised, which is carried out two to three weeks after their clear designation. In this case, the incision is made in the area of ​​viable tissue.

With dry necrosis, the underlying ailment is treated, which helps to somewhat limit the volume of dead tissues. Operational optimization of blood circulation and drug treatment are also carried out, designed to improve blood supply. Antibacterial drugs are taken to prevent secondary infection.

If the necrosis is wet, it is accompanied by the development of infection and a rather severe general intoxication, respectively, the therapy should be radical and vigorous. At an early stage of treatment, doctors try to transfer it to dry, but if such attempts do not work, the affected part of the limb is excised.

Local treatment in the treatment of wet necrosis involves washing the wound with a peroxide solution, doctors open the streaks, as well as pockets, and use different drainage techniques. In addition, the imposition of antiseptic dressings is practiced. All patients are subject to mandatory immobilization.
In parallel with local treatment, the patient is given antibiotics, detoxification solutions and vascular therapy.

At the slightest sign of necrosis, you should seek medical help.