Tissue necrosis: what is it, what are the causes and treatments? Tissue necrosis, treatment, symptoms Symptoms of necrosis

CHAPTER 13 NECROSIS (DEATHING)

In a healthy human body, cell death and regeneration constantly occur: the cells of the epidermis, the epithelium of the upper respiratory tract are exfoliated, blood cells are destroyed, and their place is taken by newly formed cells, while the functions of the organs do not suffer.

Such processes are normal for the body and contribute to its constant renewal. However, the necrosis of tissues, and sometimes entire organs, can be pathological in nature, significantly disrupting the function of organs and systems.

Necrosis is the death of tissues, whole organs or their parts in a living organism.

The reasons for the development of necrosis can be different. According to the etiology, all necrosis is divided into two large groups: direct and indirect.

Direct necrosisarise directly in the area of ​​influence of some external factor. Cell death can be caused by the action of mechanical force and is expressed to varying degrees both in closed (fractures, dislocations, ruptures, etc.) and open (wounds) injuries.

Necrosis can occur with burns under the influence of a physical (high temperature, electric current, radiation energy) or chemical (acid or alkali) factor on the body. The death of cells and tissues of the body due to the vital activity of pathogenic microorganisms is one of the components of purulent diseases and complications.

Developing under the influence of these factors, direct necrosis is very peculiar and is discussed in detail in the relevant chapters of the textbook.

This chapter focuses on the issues of etiology and pathogenesis, clinical presentation and treatment. indirect necrosis. Given the leading role in the development of indirect necrosis of the vascular factor, they are otherwise called circulatory.

Etiology and pathogenesis of circulatory necrosis

The occurrence of circulatory (indirect) necrosis is associated with malnutrition of cells and tissues in a living organism. For their development

It does not require direct external influence on a certain area of ​​the body, necrosis occurs as if by itself, due to internal causes.

Classification

The main reasons for the development of circulatory necrosis:

Violation of arterial patency;

Violation of the venous outflow;

Violation of microcirculation;

Violation of lymph circulation;

Violation of innervation.

These causes may occur acutely or gradually due to the progression of chronic diseases.

In some cases, necrosis also develops as a result of violations of systemic hemodynamics. The development of trophic ulcers (one of the types of necrosis) on the legs with arterial hypertension is described.

Acute and chronic disorders of arterial patency

Violation of arterial blood flow is the most common cause of the development of circulatory necrosis, since the lack of oxygen and nutrients to the tissues quickly causes cell death. Violation of arterial patency can occur acutely and develop gradually.

Acute violation of arterial patency

Acute violation of arterial blood supply is most dangerous due to the development of massive tissue necrosis. In this case, there are severe, with difficulty stopping pain in the limbs; the skin becomes marbled (pale with cyanotic spots), becomes cold; often there is ischemic muscle contracture, impaired sensitivity, paresthesia. Patients are forced to lower the limb down, which, due to a slight increase in blood flow, helps to reduce pain.

The most famous classification of the stages of acute ischemia, proposed by V.S. Saveliev.

Stage of functional disorders continues for several hours. Characteristic sharp pains, pallor and coldness of the extremities

ty. There are no sensory disturbances or severe limitation of movement. When the blood flow is restored, the function is completely normal.

stage of organic change. The duration of ischemia is up to 12-24 hours. The described picture is accompanied by violations of tactile and pain sensitivity and limitation of movements due to muscle contracture. Restoration of blood flow allows you to save the limb, but there is a limitation of function.

Necrotic stage usually occurs in 24-48 hours. A picture of necrosis of the limb develops, starting from its most distal parts (from the fingertips, from the foot). Restoration of blood flow in some cases only reduces the emerging zone of necrosis.

In the 1st and 2nd stages, it is necessary to restore blood flow, which will help eliminate ischemia and reverse the development of symptoms. At the 3rd stage, irreversible changes occur, a threat to the patient's life is created, therefore, the main methods of treatment are necrectomy and amputation.

The degree of developing ischemia in acute violation of arterial blood flow is largely associated with the development of collaterals in the patient in this area.

In diagnostic terms, it is extremely important to determine the pulsation of peripheral arteries. Its absence at a certain level allows you to establish a topical diagnosis of vascular damage.

To confirm the diagnosis and clarify the nature, localization and extent of the vascular lesion, special research methods are used: rheovasography, dopplerography and angiography.

The main causes of acute violation of arterial circulation:

Damage to the main vessel;

Thrombosis;

Embolism.

Damage to the main vessel

In case of injury, the artery may be crossed, compressed by bone fragments, and a pulsating hematoma may form, compressing the main vessel. At the same time, the pulsation of the artery distal to the damage zone ceases to be determined and a characteristic clinical picture of acute ischemia develops. It should be noted that with any injury, there is a pronounced pain syndrome and a change in skin color in the area of ​​injury, which can make it difficult to diagnose circulatory disorders. In this regard, it is imperative to determine the pulsation of the peripheral

arteries when examining a victim with an injury, and, if necessary, the use of special diagnostic methods.

Traumatic injuries of the arteries can conditionally include the imposition of a tourniquet on the limb for a long time, as well as accidental intraoperative ligation of the artery. So, for example, when removing the gallbladder, instead of the cystic artery, an abnormally located hepatic artery can be ligated, which can cause the development of necrosis in the liver and lead to the death of the patient.

The main methods of restoring blood flow along the damaged main artery are the imposition of a vascular suture, prosthetics or bypass of the damaged vessel.

Thrombosis

The closure of the main artery by a thrombus usually occurs against the background of a previous lesion of the vascular wall due to a chronic vascular disease, as well as an increase in blood viscosity and its coagulability.

The clinical picture is dominated by classic symptoms of acute ischemia. It should be noted that in some cases they are expressed moderately; symptoms are relieved. This is explained by the fact that as a result of the previous chronic lesion of the main artery, collaterals developed quite actively. The severity of clinical manifestations, the nature of necrosis depend on the level of thrombosis and its extent.

Restoration of blood flow in thrombosis is carried out by intima thrombectomy or bypass shunting. The earlier the operation is performed, the less the likelihood of development and the size of necrosis.

Embolism

An embolism is a blockage of a vessel by a thrombus brought by blood flow, less often by air or fat.

Depending on the location of the embolus, pulmonary embolism and embolism of the arteries of the systemic circulation (carotid, femoral, mesenteric, etc.) are distinguished.

Causes of pulmonary embolism - thrombophlebitis of the veins of the systemic circulation, most often - the veins of the lower extremities and small pelvis.

Thromboembolism of the arteries of the systemic circulation occurs in diseases of the heart (septic endocarditis, mitral stenosis).

foot valve, atrial fibrillation, etc.), as well as atherosclerosis of the aorta and its branches.

Air embolism is a consequence of a violation of the rules of infusion therapy, when air enters the patient's vessels. Its occurrence is also possible if the veins of the neck are damaged (they do not collapse well, and air can enter them during inspiration under negative pressure).

There are typical sites of thromboembolism. The embolus almost always gets stuck at the site of a bifurcation or narrowing of the vessel. Typical localizations of an embolus in the brachial artery: the space between the scalene muscles, the place of origin of the deep artery of the shoulder, the place of division into the radial and ulnar arteries; in the vessels of the lower extremities - a bifurcation of the abdominal aorta, at the place of division of the iliac artery into external and internal, at the place of origin of the deep artery of the thigh, at the exit of the femoral artery from the muscle space of the abductor muscles, at the place of division into the anterior and posterior tibial arteries.

The clinical picture of thromboembolism is the sudden onset of symptoms of acute ischemia. The severity of symptoms, as well as the incidence of extensive necrosis, is greater than with thrombosis. This is due to the fact that in most cases, emboli block the unchanged main arteries, leading to an immediate cessation of a powerful normal blood flow, and collaterals are usually not yet developed.

The method of treatment is embolectomy (except for extreme ischemia), and with previous vascular damage, reconstructive surgery.

There are direct and indirect embolectomy.

At straight embolectomy make an incision in the area of ​​the embolus, open the artery, mechanically remove the embolus and apply a vascular suture. Currently, direct embolectomy has given way to indirect (Fogarty's operation).

Advantages indirect embolectomy:

It is not necessary to know exactly the location of the embolus;

The operation is performed from the most convenient places for access (both in the proximal and distal direction);

Dissection of the artery is performed in the intact area, which reduces the risk of thrombosis.

To perform an indirect embolectomy, a Fogarty catheter is used - a catheter with a special rubber balloon at the end.

After making a typical access to the corresponding main artery, the latter is opened and a Fogarty catheter is inserted into its lumen (Fig. 13-1).

Rice. 13-1.Indirect embolectomy with a Fogarty catheter: a - Fogarty catheter; b - removal of the embolus in the proximal and distal direction

The catheter is advanced deliberately beyond the thrombus localization zone, the balloon is inflated with a syringe with an inert solution and the catheter is pulled out, while removing the embolus in the artery and restoring blood flow.

Chronic arterial obstruction

A gradual decrease in the diameter of the artery (stenosis) up to a complete blockage develops with the so-called obliterating diseases. The most common among them obliterating atherosclerosis and obliterating endarteritis.

Obliterating diseases affect various great vessels (carotid, coronary, mesenteric, renal arteries), but in surgery, damage to the vessels of the lower extremities is of particular importance, most often causing the development of necrosis.

Clinical picture

The main symptom in the clinical picture of obliterating diseases in the development of chronic limb ischemia is the symptom intermittent claudication: when walking, pronounced pains in the calf muscles appear, which forces the patient to stop, while the pain subsides and he can walk again, then the situation repeats.

The severity of the symptom of intermittent claudication indicates the depth of circulatory disorders in the extremities and determines the degree of chronic ischemia:

I degree - the occurrence of pain after 500 m of walking;

II degree - after 200 m of walking;

III degree - after walking less than 50 m and at rest;

IV degree - the appearance of foci of necrosis.

Complaints of patients on coldness of the feet and legs, paresthesia are characteristic.

The most important predisposing factor for the development of obliterating diseases of the vessels of the lower extremities is smoking (!).

An objective study notes hypotrophy of the limb; reduction of hairline; the limb is pale, cold to the touch. With IV degree of ischemia, necrosis occurs (trophic ulcers, gangrene). Localization of necrosis on the fingers (especially on the distal phalanges) and in the heel region is characteristic. This is due to the greatest distance of these zones from the heart, which creates the worst conditions for blood supply.

For topical diagnosis of vascular lesions, it is necessary to determine the pulsation of the main vessels, conduct dopplerography and angiography.

Clinical differences between obliterating atherosclerosis and endarteritis

Despite the fact that obliterating atherosclerosis and obliterating endarteritis cause the development of chronic limb ischemia, they have a number of significant differences. The main features of the clinical course of diseases are presented in Table. 13-1.

Table 13.1.Clinical differences between obliterating atherosclerosis and obliterating endarteritis

Methods of treatment of chronic violation of arterial patency are divided into conservative and surgical.

Conservative treatment

Carry out complex treatment. Taking into account the characteristics of the disease, indications and contraindications, the following drugs and methods are used:

Antispasmodics (drotaverine, nicotinic acid);

Anticoagulants (heparin sodium, phenindione);

Angioprotectors (pentoxifylline);

Prostaglandin E preparations (alprostadil);

Drugs that increase the resistance of tissues to hypoxia;

Physiotherapeutic effect on the lumbar sympathetic ganglia.

Surgery

Lumbar sympathectomy interrupts sympathetic innervation, reducing spastic contraction of the vessels of the lower extremities, and promotes the opening of collaterals. Improved blood flow

non-radical, which makes the method close to the conservative treatment of the disease.

Intimothrombectomy (endarterectomy) - removal of an atherosclerotic plaque with thrombotic masses along with the intima of the vessel. Used for local narrowing of the vessel due to the pathological process. There are open and semi-closed intima thrombectomy (Fig. 13-2).

Rice. 13-2.Intimotrobectomy according to Dos Santos: a - open; b - semi-closed (with the help of a loop and desobliterotome)

Prosthetics and shunting. The affected area of ​​the vessel is replaced with a prosthesis (prosthetics) or above and below the site of stenosis into the vessel

Rice. 13-3.Femoral-popliteal autogenous vein shunting

Rice. 13-4.Aortofemoral bifurcation bypass with a synthetic prosthesis

a shunt is sewn in, creating conditions for a roundabout blood flow (shunting). As prostheses, an autovein (a large saphenous vein of the patient's thigh) or synthetic prostheses made of lavsan, velor, etc. are more often used (Fig. 13-3 and 13-4). In some cases, an allograft from the vessels of the umbilical cord is used. For shunting vessels of medium and small caliber, the “bypass in situ” shunting technique is used (instead of the affected artery, the blood flow is “let” through the vein located here in the opposite direction using proximal and distal anastomoses with the corresponding arteries, having previously destroyed the valves of the vein with a special stripper).

The methods of endovascular surgery are based on the introduction of special catheters and instruments into the lumen of the artery, which allow, under X-ray control, dilatation of the stenotic section of the artery (using a special catheter with a balloon at the end), laser recanalization (an atherosclerotic plaque is "burned" by a laser beam), installation of a peculiar vessel frame (stent).

Violation of the venous outflow

Violation of the venous outflow, as well as the inflow of arterial blood, worsens the conditions for the vital activity of cells and tissues, however, the consequences of these violations are distinguished by a certain originality.

Differences in necrosis in violation

venous outflow and arterial blood supply

In violation of the venous outflow, clinical manifestations occur more slowly, edema and cyanosis of the skin prevail. In the absence of inflammation, the pain syndrome is moderately expressed. Bo-

The development of small superficial necrosis (trophic ulcers) is more characteristic, while extensive necrosis and gangrene of the extremities occur more often in violation of arterial blood supply (trophic ulcers are also possible). With venous pathology, the development of gangrene without infection does not occur.

At the same time, if the venous outflow is disturbed, pronounced trophic disorders of the skin and subcutaneous tissue occur: tissue thickening (induration) is characteristic, they become brown (pigmentation).

Characteristic localization of necrosis. With arterial insufficiency, tissue necrosis usually begins at the fingertips and heel region, that is, in the places most distant from the heart. In case of venous insufficiency, due to the peculiarities of the structure of the venous bed of the lower extremities, the worst conditions for tissues are created in the region of the medial malleolus and in the lower third of the lower leg, where trophic ulcers usually form.

Violations of the venous outflow can be acute or chronic.

Acute violation of the venous outflow

Acute violation of the venous outflow can be caused by acute thrombophlebitis, thrombosis and damage to the main veins.

For the development of necrosis, the defeat of the deep veins of the lower extremities is important. Damage to superficial veins is dangerous only as a source of thromboembolism.

Clinical picture

Acute deep vein thrombosis is manifested by the sudden appearance of moderate aching pain in the limb, aggravated by movement, as well as progressive edema and cyanosis of the skin. Clearly contoured, superficial veins bulge. On palpation, there is a sharp pain along the neurovascular bundle.

Similar symptoms, with the exception of pain and soreness, occur when deep veins are damaged (compressed). An obvious clinical picture usually does not require the use of special diagnostic methods. The diagnosis can be confirmed with a Doppler study.

In acute disorders of the venous outflow, necrosis usually appears in the long term and is represented by trophic ulcers. Extensive necrosis in the acute period is rare.

Treatment

Acute violation of the venous outflow is treated conservatively with the following drugs:

Disaggregants (acetylsalicylic acid, dipyridamole, pentoxifylline);

Anticoagulants (heparin sodium, enoxaparin sodium, phenindione);

Methods and preparations for improving the rheological properties of blood (UVR and laser irradiation of autologous blood, dextran [mol.wt. 30,000-40,000]);

Anti-inflammatory drugs (diclofenac, ketoprofen, naproxen, etc.);

Indications for surgical intervention occur with thrombophlebitis of superficial veins in the following cases:

Ascending thrombophlebitis with the risk of the process moving to deep veins and the development of thromboembolism - the proximal ligation and transection of the vein are performed;

Abscessing - produce an opening of abscesses or excision of thrombosed veins along with the surrounding tissue.

Chronic violation of the venous outflow

Among chronic vein diseases in the development of necrosis, two are of primary importance: varicose and post-thrombotic diseases of the lower extremities.

Varicose disease

clinical picture. The most characteristic manifestation is varicose saphenous veins: the saphenous veins in the vertical position of the patient swell, tense, have a tortuous character. Patients complain of a cosmetic defect, as well as a feeling of heaviness in the limb by the end of the day, cramps at night. The disease usually progresses slowly. Slowing blood flow in dilated veins contributes to the development of trophic disorders. Edema, cyanosis, tissue induration and skin pigmentation gradually appear.

Trophic disorders are most pronounced in the lower third of the lower leg, in the region of the medial malleolus, where subsequently a focus of necrosis appears - a trophic ulcer.

To determine the tactics of treatment, special tests are used (marching, two-bandage tests, etc.), as well as additional methods.

research methods (rheovasography, dopplerography, radiopaque phlebography).

Surgery. Phlebectomy is performed - removal of varicose veins, while the main trunk of the great saphenous vein is usually removed, insolvent communicating veins are ligated. In case of failure of the deep vein valves, they are extravasally corrected with the help of special spirals.

sclerosing therapy. Special substances (lauromacrogol 400) are injected into varicose veins, causing thrombosis and a sclerosing process with complete obliteration of the vein.

Conservative treatment does not cure the disease, but prevents its progression. The main methods: wearing elastic bandages, the use of angioprotectors and venotonic agents (diosmin + hesperidin, troxerutin).

Post-thrombotic disease

clinical picture. Post-thrombotic disease usually begins with acute deep vein thrombosis. As a result of the transferred process, the outflow through the deep veins is disturbed, which is accompanied by the appearance of edema of the limb, a feeling of heaviness in it, cyanosis. Trophic disorders gradually appear and progress: induration and pigmentation of the skin in the lower third of the leg, then trophic ulcers form. Perhaps the development of secondary varicose saphenous veins, which bear the main burden of ensuring the outflow of blood. Subsequently, the patency of deep veins can be restored (recanalization stage).

Violation of the patency of deep veins is detected clinically, as well as using dopplerography and radiopaque phlebography.

Conservative treatment - main method. Once every 5-6 months, patients undergo a course of vascular therapy:

Disaggregants (acetylsalicylic acid, dipyridamole, pentoxifylline);

Anticoagulants (phenindione);

Methods and preparations for improving the rheological properties of blood (UVR and laser irradiation of autologous blood, dextran [mol.wt. 30,000-40,000]);

Angioprotectors and venotonic agents (diosmin + hesperidin, troxerutin).

Surgery. In case of complete blockage of the veins of the ileofemoral segment, surgical interventions are used to restore venous outflow from the limb. The most common opera

tion Palma: on a healthy limb, they secrete v. saphena magna, cut off in the lower third of the thigh while maintaining the mouth; the cut off distal end of the vein is passed over the womb to the opposite side and anastomosed with the deep vein of the thigh below the blockage. Thus, the outflow from the diseased limb along the displaced v. saphena magna carried out through the deep veins of a healthy limb.

Restoration of vein patency by their surgical recanalization (similar to arterial recanalization) is usually not performed, which is associated with a high incidence of thrombosis, as well as the risk of damage to the thin venous wall.

Violation of microcirculation

Violation of microcirculation can also lead to the development of necrosis. The main diseases in which microcirculation disorders occur are diabetes mellitus (diabetic foot), systemic vasculitis, bedsores.

diabetic foot

With diabetes mellitus, angiopathy gradually develops, which is expressed mainly in arteriolosclerosis. The defeat is systemic. The vessels of the retina, kidneys, etc. are affected, but for the development of necrosis, damage to the vessels of the lower extremities, in particular, the feet, is of primary importance. At the same time, along with angiopathy, diabetic polyneuropathy develops, leading to a decrease in sensitivity, impaired immune status with a decrease in resistance to infection and a slowdown in reparative processes.

These changes in the complex received a special name "diabetic foot". A feature of the diabetic foot is a combination of an infectious onset and inflammation with microcirculatory necrosis, a decrease in immune and reparative processes.

It is very difficult to treat such patients. Active surgical tactics (necrectomy, opening of purulent streaks), antibiotic therapy, correction of blood glucose concentration and microcirculatory disorders are required.

Systemic vasculitis

Systemic vasculitis is a heterogeneous group of diseases in which a pathological process occurs, characterized by inflammation.

degeneration and necrosis of the vascular wall, leading to ischemic changes in organs and tissues.

Vasculitis includes nodular periarteritis, Schoenlein-Genoch disease. The treatment of these diseases is individual, using complex schemes with the use of hormonal drugs, cytostatics, immunomodulators and other drugs.

bedsores

With bedsores, the development of necrosis due to impaired microcirculation occurs due to prolonged tissue compression. Diagnosis, prevention and treatment of bedsores are discussed in Chapter 9. In addition, it should be noted that pressure ulcers develop not only when the patient is in bed for a long time. Necrosis of the tracheal wall during prolonged intubation, necrosis of the mucous membrane of the esophagus and stomach from a nasogastric tube, necrosis of the intestinal wall during prolonged stay of the drainage in the abdominal cavity are also commonly called bedsores, given the mechanism of their development. Prevention of bedsores of this kind is the early removal of drains, the use of tubes made of inert soft materials.

Violation of lymph circulation

The main disease in which lymphatic circulation is disturbed is lymphedema. With lymphedema, due to various etiological factors, the outflow of lymph from organs (most often from the lower extremities) is disturbed. This leads to the appearance of edema, the accumulation of acid mucopolysaccharides in the skin and subcutaneous tissue, and the development of massive fibrosis.

The final stage of lymphedema is fibroedema (elephantiasis) of the extremities. At the same time, the limb is sharply enlarged in size due to fibrosis of the skin and subcutaneous tissue, the skin is thickened, often with many cracks and proliferation of papillae, skin areas hang down in the form of a kind of aprons. Against this background, the formation of superficial necrosis (trophic ulcers) with abundant lymphorrhea is possible. In the early stages of lymphedema, necrosis does not form.

Violation of innervation

The trophic function of nerves is less important for the normal functioning of tissues than blood supply, but at the same time, a violation of innervation can lead to the development of superficial necrosis - neurotrophic ulcers.

A feature of neurotrophic ulcers is a sharp inhibition of reparative processes. This is largely due to the fact that it is difficult to eliminate or at least reduce the influence of the etiological factor (impaired innervation).

Neurotrophic ulcers can form with damage and diseases of the spinal cord (spinal injury, syringomyelia), damage to peripheral nerves.

The main types of necrosis

All of the above diseases lead to the development of necrosis. But the types of necrosis themselves are different, which has a significant impact on the tactics of treatment.

Dry and wet necrosis

It is fundamentally important to separate all necrosis into dry and wet.

Dry (coagulative) necrosis characterized by gradual drying of dead tissues with a decrease in their volume (mummification) and the formation of a clear demarcation line separating dead tissues from normal, viable ones. In this case, the infection does not join, the inflammatory reaction is practically absent. The general reaction of the body is not expressed, there are no signs of intoxication.

Wet (colliquation) necrosis characterized by the development of edema, inflammation, an increase in the volume of the organ, while hyperemia is expressed around the foci of necrotic tissues, there are blisters with a clear or hemorrhagic fluid, the outflow of cloudy exudate from skin defects. There is no clear boundary between the affected and intact tissues: inflammation and edema spread beyond the necrotic tissues for a considerable distance. Characterized by the addition of a purulent infection. With wet necrosis, severe intoxication develops (high fever, chills, tachycardia, shortness of breath, headaches, weakness, profuse sweat, changes in blood tests of an inflammatory and toxic nature), which, when the process progresses, can lead to impaired organ function and death of the patient. The differences between dry and wet necrosis are presented in Table. 13-2.

Thus, dry necrosis proceeds more favorably, is limited to a smaller volume of dead tissues and carries a much lower threat to the patient's life. In what cases does dry necrosis develop, and in what cases does it develop wet necrosis?

Table 13-2.Main differences between dry and wet necrosis

Dry necrosis is usually formed when the blood supply to a small, limited area of ​​\u200b\u200btissues is disturbed, which does not occur immediately, but gradually. More often, dry necrosis develops in patients with reduced nutrition, when there is practically no fatty tissue rich in water. For the occurrence of dry necrosis, it is necessary that pathogenic microorganisms are absent in this zone, so that the patient does not have concomitant diseases that significantly impair immune responses and reparative processes.

Unlike dry necrosis, the development of wet is promoted by:

Acute onset of the process (damage to the main vessel, thrombosis, embolism);

Ischemia of a large volume of tissues (for example, thrombosis of the femoral artery);

Expression in the affected area of ​​tissues rich in fluid (fatty tissue, muscles);

Accession of an infection;

Concomitant diseases (immunodeficiency states, diabetes mellitus, foci of infection in the body, insufficiency of the circulatory system, etc.).

Gangrene

Gangrene is a certain type of necrosis, characterized by a characteristic appearance and extensiveness of the lesion, in the pathogenesis of which the vascular factor is essential.

The characteristic appearance of fabrics is their black or gray-green color. This color change is due to the decomposition of hemoglobin upon contact with air. Therefore, gangrene can develop only in organs that have communication with the external environment, air (limbs, intestines, appendix, lungs, gallbladder, mammary gland). For this reason, there is no gangrene of the brain, liver, pancreas. Foci of necrosis in these organs outwardly look quite different.

Table 13-3.Differences between trophic ulcers and wounds

The defeat of the whole organ or a large part of it. It is possible to develop gangrene of the finger, foot, limb, gallbladder, lung, etc. At the same time, there cannot be gangrene of a limited part of the body, the back surface of the finger, etc.

In the pathogenesis of necrosis, the vascular factor is of primary importance. Its influence can affect both at the beginning of the development of necrosis (ischemic gangrene), and at a later stage (impaired blood supply and microcirculation with purulent inflammation). Like all types of necrosis, gangrene can be dry or wet.

Trophic ulcer

A trophic ulcer is a superficial defect of integumentary tissues with a possible lesion of deeper tissues that does not tend to heal.

Trophic ulcers are usually formed in chronic circulatory and innervation disorders. According to the etiology, atherosclerotic, venous and neurotrophic ulcers are distinguished.

Considering that with a trophic ulcer, as with a wound, there is a defect in the integumentary tissues, it is important to determine their differences from each other (Table 13-3).

The wound is characterized by a short period of existence and changes in accordance with the phases of the wound process. Usually the healing process is completed in 6-8 weeks. If this does not happen, then the reparative processes slow down sharply, and starting from the second month of existence, any defect in the integumentary tissues is usually called a trophic ulcer.

A trophic ulcer is always in the center of trophic disorders, covered with sluggish granulations, on the surface of which there is fibrin, necrotic tissues and pathogenic microflora.

Fistulas

A fistula is a pathological passage in tissues that connects an organ, a natural or pathological cavity with the external environment, or organs (cavities) with each other.

The fistulous tract is usually lined with epithelium or granulations.

If the fistula communicates with the external environment, the fistula is called external; if it connects internal organs or cavities - internal. Fistulas can be congenital and acquired, can be formed independently, due to the course of the pathological process (fistulas in osteomyelitis, ligature fistulas, fistula between the gallbladder and stomach with a prolonged inflammatory process), or they can be created artificially (gastrostomy for feeding with burns of the esophagus, colostomy for intestinal obstruction).

The examples given show how diverse fistulas can be. Their features, methods of diagnosis and treatment are associated with the study of diseases of the corresponding organs and are the subject of private surgery.

General principles of treatment

With necrosis, local and general treatment is carried out. At the same time, there are fundamental differences in tactics and methods of treatment of dry and wet necrosis.

Treatment of dry necrosis

The treatment of dry necrosis is aimed at reducing the area of ​​dead tissues and maximizing the preservation of the organ (limb).

Local treatment

The objectives of the local treatment of dry necrosis are primarily the prevention of infection and drying of tissues. To do this, use the treatment of the skin around the necrosis with antiseptics and the use of dressings with ethyl alcohol, boric acid or chlorhexidine. It is possible to treat the necrosis zone with a 1% alcohol solution of brilliant green or a 5% solution of potassium permanganate.

After the formation of a clear demarcation line (usually after 2-3 weeks), a necrectomy is performed (resection of the phalanx, amputation of the finger,

foot), while the incision line should pass in the zone of unchanged tissues, but as close as possible to the demarcation line.

General treatment

With dry necrosis, the general treatment is primarily of an etiotropic nature, it is aimed at the underlying disease that caused the development of necrosis. This treatment allows you to limit the area of ​​necrosis to a minimum amount of tissue. The most effective measures should be taken. If it is possible to restore the blood supply by intima thrombectomy, shunting, this should be done. In addition, conservative therapy is carried out aimed at improving blood circulation in the affected organ (treatment of chronic arterial diseases, disorders of venous outflow and microcirculation).

Antibiotic therapy is of great importance for the prevention of infectious complications.

Treatment of wet necrosis

Wet necrosis, accompanied by the development of infection and severe intoxication, poses a direct threat to the patient's life. Therefore, with their development, more radical and vigorous treatment is necessary.

At an early stage, the task of treatment is to try to convert wet necrosis into dry. If the desired result cannot be achieved or the process has gone too far, the main task is the radical removal of the necrotic part of the organ (limb) within the known healthy tissues (high amputation).

Treatment in the early stages Local treatment

To transfer wet necrosis to dry, local washing of the wound with antiseptics (3% hydrogen peroxide solution), opening of streaks and pockets, draining them, dressings with antiseptic solutions (boric acid, chlorhexidine, nitrofural) are used. Immobilization of the affected limb is mandatory. The skin is treated with tanning antiseptics (96% alcohol, brilliant green).

General treatment

In general treatment, the main thing is to conduct powerful antibacterial therapy, including intra-arterial administration of antibiotics. Given the presence of intoxication, detoxification therapy, correction of the function of organs and systems, as well as a complex of vascular therapy are carried out.

Surgery

Usually, it takes 1-2 days to try to transfer wet necrosis to dry, although in each case the issue is decided individually. If edema decreases during treatment, inflammation subsides, intoxication decreases, the number of necrotic tissues does not increase, conservative treatment can be continued. If after a few hours (or a day) it is clear that there is no effect from the treatment, inflammatory changes progress, necrosis spreads, intoxication increases, then the patient should be operated on, since this is the only way to save his life.

In cases where a patient is admitted to a hospital with wet gangrene of the limb, severe inflammation and severe intoxication, it is not necessary to try to convert wet necrosis into dry, short-term preoperative preparation (infusion therapy for 2 hours) should be carried out and the patient should be operated on according to emergency indications.

In case of wet necrosis, surgical treatment consists in the removal of necrotic tissues within obviously healthy, unchanged tissues. Unlike dry necrosis, given the greater severity of the inflammatory process, the addition of infection, in most cases, a high amputation is performed. So, with wet necrosis of the foot, for example, with the spread of hyperemia and edema to the upper third of the lower leg (a fairly common situation), amputation should be performed on the thigh, and preferably at the level of the middle third. Such a high level of amputation is due to the fact that pathogenic microorganisms are found in tissues even above the visible border of the inflammatory process. When amputation is performed close to the area of ​​necrosis, the development of severe postoperative complications from the stump is very likely (progression of the infectious process, suppuration of the wound, development of necrosis), which significantly worsen the general condition of the patient and the prognosis for his recovery. In some cases, an even higher amputation has to be repeated.

Treatment of trophic ulcers

The treatment of trophic ulcers, the most common type of necrosis, requires additional consideration due to the peculiarities of this pathological condition.

For trophic ulcers, local and general treatment is used.

Local treatment

In the local treatment of a trophic ulcer, the surgeon faces three tasks: fighting infection, cleaning the ulcer from necrotic tissues, and closing the defect.

Infection control

The fight against infection is carried out by daily dressings, in which the skin around the ulcer is treated with alcohol or alcoholic tincture of iodine, the ulcerous surface itself is washed with a 3% solution of hydrogen peroxide and bandages are applied with an antiseptic solution (3% solution of boric acid, an aqueous solution of chlorhexidine, nitrofural).

Cleansing of necrotic tissue

To cleanse the ulcerative surface from necrotic tissues during dressings, in addition to treating the ulcerative surface with various antiseptics, necrectomy and proteolytic enzymes (chymotrypsin) are used. Local use of sorbents is possible. Physiotherapy successfully supplements the treatment (electrophoresis with enzymes, sinusoidal modulated currents, magnetotherapy, quartz treatment).

A feature of trophic ulcers is that ointment dressings should not be used at any stage of treatment!

Defect closure

After the ulcer surface has been cleaned and the pathogenic microflora has been destroyed, attempts should be made to close the wound defect. With small ulcers, this process takes place on its own, after cleansing the ulcer, the growth of granulations increases, and marginal epithelialization appears. At the same time, daily dressings should be continued using wet-drying dressings with antiseptics. In cases where the defect becomes small (less than 1 cm in diameter) and superficial, it is possible to switch to processing it with 1% alcohol

brilliant green solution or 5% potassium permanganate solution, causing the formation of a scab, under which epithelialization subsequently occurs. Epithelialization is also facilitated by the use of a gel (iruksol).

To close the ulcer after its cleansing, in some cases, free skin grafting or excision of the ulcer with plasty with local tissues can be used. However, these measures should be carried out after a targeted impact on the cause of the ulcer.

For the healing of venous (but not atherosclerotic!) trophic ulcers is effective compression therapy. Under the compression therapy of trophic ulcers is understood the imposition of a zinc-gelatin bandage on the limb, for which various modifications of the Unna paste are used. Rp.: Zinci oxydati

Gelatinae ana 100.0

Glycerini 600.0

Aqua destil. 200.0

M.f. pasta.

Bandage technique. The patient is laid on the table, the lower limb is raised, after which the heated paste is applied with a brush from the base of the fingers to the upper third of the lower leg (including the zone of the trophic ulcer). This is followed by a layer of gauze bandage. Then again apply a layer of paste with a brush, soaking the bandage with it. In total, 3-4 layers of dressing are applied in this way.

The bandage is not removed for 1-2 months. After its removal, almost all trophic ulcers up to 5 cm in size with a previously cleaned ulcer surface are epithelized.

Compression therapy significantly increases the possibility of ulcer closure, but not for a long period. The method does not allow to cure the patient of trophic disorders, as it does not eliminate the cause of the disease.

General treatment

The general treatment for trophic ulcers is primarily aimed at the cause of their development and consists in various ways to improve blood circulation. In this case, both conservative and surgical methods are used. So, for example, in the presence of a trophic ulcer due to varicose veins, in some cases, after cleansing the ulcer and suppressing the infection, phlebectomy is performed (removal of va-

Irreversible processes of necrosis of body tissues under the influence of internal or external agents are called necrosis in medicine. For a person, such a pathological condition is very dangerous, can lead to serious consequences. Treatment of necrotic changes should be carried out strictly under the supervision of highly qualified doctors in a hospital setting.

Causes of tissue necrosis

Before treating a dangerous disease, it is important to find out what factors provoke it. Predominantly tissue death begins due to circulatory disorders. In some cases, necrosis develops due to diabetes mellitus, damage to large nerves, and spinal cord injuries. Other possible causes of tissue breakdown are described below:

1. Physical necrosis develops under the influence of low or high temperatures, radiation, electric current, various injuries, gunshot wounds, and so on.
2. Biological tissue necrosis appears under the influence of bacteria and viruses.
3. Allergic necrosis develops due to infection with infectious diseases provoked by a certain irritant, causing fibrinoid tissue damage.
4. Toxic necrosis appears under the influence of toxic substances on the patient's body.
5. Vascular necrosis (heart attack) develops when there is a violation of blood circulation in the tissues and internal organs of a person.
6. Trophic deaths provoke bedsores and non-healing wounds. A condition develops after a violation of the process of blood microcirculation or innervation (connections of organs with the central nervous system).

Types of tissue necrosis

To assess the nature of the pathology and prescribe the correct treatment, it is necessary to determine the type of necrotic damage. The disease is classified according to clinical, etiological and morphological features. Belonging to a certain group depends on the conditions for the development of pathology, the characteristics of the affected tissue. There are the following types of necrosis:

1. Dry (coagulation) affects structures saturated with protein (spleen, kidneys, liver). It is characterized by dehydration, compaction. This type includes caseous (cottage cheese), Zenker's (waxy), fibrinoid lesions, necrosis of fatty tissues.
2. Wet (colliquation) affects structures rich in moisture (spinal cord or brain). The disease develops due to autolytic decay, provoking liquefaction.
3. A heart attack develops due to a sudden complete or partial disruption of the process of blood supply to organs.
4. Pressure ulcers are local lesions due to impaired circulation caused by constant compression.
5. Gangrene develops when tissues come into contact with the external environment. According to the place of localization, it is divided into gas, dry, wet. It is characterized by edema, crepitus, depending on the specific type.
6. A sequester is a section of a dead structure (mainly bone) that does not undergo autolysis (self-dissolution).

The origin of the pathological condition is also important. According to this parameter, tissue death is divided into the following types:

1. Traumatic (primary or secondary) - develop under the influence of a pathogenic agent, is one of the direct necrosis.
2. Ischemic ones occur due to problems with peripheral circulation, thrombosis, low oxygen content in the blood, blockage of blood vessels.
3. Allergic are included in the group of indirect necrotic lesions. This type of disease occurs due to the individual reaction of the body to stimuli.
4. Toxigenic develop under the influence of toxic substances of various types.
5. Trophoneurotic lesions appear due to malfunctions in the central or peripheral nervous system, provoke violations of the innervation of the skin or internal organs.

Symptoms

The beginning of the irreversible death of body structures is characterized by tingling, numbness of the legs or arms, loss of sensation in the damaged area. In addition, the patient's skin becomes pale, shiny. Over time, due to the cessation of blood circulation, it becomes first cyanotic, later dark green and even black. If the necrotic lesion is caused by poisoning, then the general well-being of the patient may deteriorate, the nervous system may become exhausted. In addition, the patient experiences rapid fatigue.

In order to take action in time, you need to pay attention to the first signs of the disease. The main symptoms of the death of the skin, bones or internal organs are as follows:

• loss of sensation;
• hyperemia of the skin;
• numbness;
• coldness in limbs;
• puffiness;
• convulsions;
• dyspnea;
• change in respiratory rhythm;
• general weakness;
• permanent increase in body temperature;
• loss of appetite;
• trophic ulcers;
• increase in heart rate.

stages

By their nature, necrotic lesions are a terrible disease. The disease goes through several stages, each of which has its own characteristic features. Below are the stages of development of the pathological condition:

1. Paranecrosis (or cell death). At this stage, the death process is reversible, provided that the correct treatment is carried out. Timely medical care can prevent the development of complications.
2. Necrobiosis. At this stage, the process of destruction already becomes irreversible. With necrobiosis, the metabolism in tissues is disturbed, new healthy cells are not formed.
3. Withering away. If apoptosis is a natural, genetically determined death, then cell death in this case occurs under the influence of pathogenic factors and has negative consequences for the body.
4. Autolysis. At this stage, the complete decomposition of the dead structures of the body occurs. The process is triggered by enzymes secreted by dead cells.

Diagnostics

In order to provide qualified assistance to the patient and start treatment on time, it is important to determine where the necrotic tissues are located and what is the extent of the problem. For these purposes The following methods of medical diagnostics are used:

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

The presented types of research help to determine the exact localization of the affected area, its size, features. By identifying characteristic changes, the stage and form of the disease, making an accurate diagnosis, doctors can prescribe an effective treatment for the patient. Superficial necrotic lesions are not difficult to diagnose. These include gangrene of the extremities and so on. The development of this disease is determined by the patient's complaints, the presence of cyanotic or green skin in the affected area.

Treatment of tissue necrosis

Timely diagnosis and identification of the cause of necrosis are important components of successful therapy. This disease requires immediate admission of the patient to the hospital. Drug therapy for tissue necrosis is usually aimed at restoring blood flow. If necessary, detoxification therapy can be carried out, antibiotics can be prescribed. In difficult cases, the patient is sent for surgery.

Skin necrosis in the initial stages can be treated at home. For this, the following effective traditional medicine is used:

• chestnut baths;
• oak bark ash;
• pork fat ointment
• slaked lime.

dry necrosis therapy

Treatment may vary depending on the type of disease. Dry necrosis is treated in two stages. The first is drying the tissues, restoring blood circulation and preventing further spread of the disease. The area near the area affected by necrosis is treated with an antiseptic. After disinfecting the site, a bandage soaked in Boric acid, ethyl alcohol or Chlorhexidine is applied to it. During the first stage of therapy, the tissues affected by necrosis are dried. To do this, they are treated with a solution of potassium permanganate or brilliant green.

The second stage is the excision of non-viable tissues. Depending on the degree of necrotic lesion, the patient can cut off the foot or make a resection of the phalanx. All manipulations should be aimed at restoring blood circulation in damaged organs. In addition, it is important to exclude the cause that provoked the disease. To avoid bacterial infection of dead tissue, the patient is prescribed antibiotic therapy. Otherwise, serious complications, up to a lethal outcome, are possible.

Wet necrosis therapy

In cases with necrotic lesions of the wet type, treatment is prescribed taking into account the degree of damage to the organ. This type of pathological condition is more dangerous for humans. Doctors at the initial stage are trying to convert wet necrosis into a dry one. The early stages of the disease allow this to be done. If it is not possible to change the level of necrosis, then the patient is sent for surgery.

Incorrect injection technique

needle breakage, air or drug embolism, allergic reactions, tissue necrosis, hematoma

Infiltrate is the most common complication after subcutaneous and intramuscular injections. Most often, infiltration occurs if: a) the injection is made with a blunt needle; b) for intramuscular injection, a short needle is used, designed for intradermal or subcutaneous injections. Inaccurate choice of injection site, frequent injections in the same place, violation of asepsis rules are also the cause of infiltrates.

Abscess - purulent inflammation of soft tissues with the formation of a cavity filled with pus. The reasons for the formation of abscesses are the same as infiltrates. In this case, infection of soft tissues occurs as a result of violation of the rules of asepsis.

Breakage of the needle during the injection is possible when using old worn-out needles, as well as with a sharp contraction of the muscles of the buttocks during an intramuscular injection, if a preliminary conversation was not held with the patient before the injection or the injection was made to the patient in a standing position.

Drug embolism can occur when oil solutions are injected subcutaneously or intramuscularly (oil solutions are not injected intravenously!) And the needle enters the vessel. The oil, once in the artery, clogs it, and this will lead to malnutrition of the surrounding tissues, their necrosis. Signs of necrosis: increasing pain in the injection area, swelling, redness or red-cyanotic coloration of the skin, an increase in local and general temperature. If the oil is in a vein, then with the blood flow it will enter the pulmonary vessels. Symptoms of pulmonary embolism: a sudden attack of suffocation, coughing, blue upper torso (cyanosis), chest tightness.

Air embolism with intravenous injections is the same formidable complication as oil embolism. The signs of embolism are the same, but they appear very quickly, within a minute.

Damage to the nerve trunks can occur with intramuscular and intravenous injections, either mechanically (with the wrong choice of injection site), or chemically, when the drug depot is near the nerve, as well as when the vessel supplying the nerve is blocked. The severity of the complication can be different - from neuritis to limb paralysis.

Thrombophlebitis - inflammation of a vein with the formation of a blood clot in it - is observed with frequent venipuncture of the same vein, or when using blunt needles. Signs of thrombophlebitis are pain, hyperemia of the skin and the formation of an infiltrate along the vein. The temperature may be subfebrile.

Tissue necrosis can develop with an unsuccessful puncture of a vein and the erroneous injection of a significant amount of an irritant under the skin. The ingress of drugs along the course during venipuncture is possible due to: piercing the vein ‘through’; failure to enter the vein initially. Most often this happens with the inept intravenous administration of a 10% solution of calcium chloride. If the solution still gets under the skin, you should immediately apply a tourniquet above the injection site, then inject 0.9% sodium chloride solution into and around the injection site, only 50-80 ml (will reduce the concentration of the drug).

A hematoma can also occur during an inept venipuncture: a purple spot appears under the skin, because. the needle pierced both walls of the vein and the blood penetrated into the tissues. In this case, the puncture of the vein should be stopped and pressed for several minutes with cotton wool and alcohol. The necessary intravenous injection in this case is made into another vein, and a local warming compress is placed on the hematoma area.

Allergic reactions to the introduction of a particular drug by injection can occur in the form of urticaria, acute rhinitis, acute conjunctivitis, Quincke's edema, often occurring after 20-30 minutes. after drug administration. The most formidable form of an allergic reaction is anaphylactic shock.

Anaphylactic shock develops within seconds or minutes of drug administration. The faster the shock develops, the worse the prognosis.

The main symptoms of anaphylactic shock: a feeling of heat in the body, a feeling of tightness in the chest, suffocation, dizziness, headache, anxiety, severe weakness, lowering blood pressure, heart rhythm disturbances. In severe cases, symptoms of collapse join these signs, and death can occur within a few minutes after the onset of the first symptoms of anaphylactic shock. Therapeutic measures for anaphylactic shock should be carried out immediately upon detection of a sensation of heat in the body.

Long-term complications that occur two to four months after the injection are viral hepatitis B, D, C, as well as HIV infection.

Viruses of parenteral hepatitis are found in significant concentrations in blood and semen; in lower concentrations are found in saliva, urine, bile and other secrets, both in patients with hepatitis and in healthy virus carriers. The method of transmission of the virus can be blood transfusions and blood substitutes, medical and diagnostic manipulations, in which there is a violation of the skin and mucous membranes.

Those at highest risk of contracting the hepatitis B virus are people who inject.

According to V.P. Wenzel (1990), the first method of transmission of viral hepatitis B is marked by needle sticks or injuries with sharp instruments (88%). Moreover, these cases, as a rule, are due to a careless attitude to used needles and their repeated use. Transmission of the pathogen can also occur through the hands of the person performing the manipulation and having bleeding warts and other diseases of the hands, accompanied by exudative manifestations.

The high risk of infection is due to:

high resistance of the virus in the external environment; the duration of the incubation period (six months or more);

a large number of asymptomatic carriers.

Currently, there is a specific prevention of viral hepatitis B, which is carried out by vaccination.

In order to protect yourself from HIV infection, each patient should be considered as a potential HIV-infected person, since even a negative result of a patient's serum test for the presence of antibodies to HIV can be a false negative. This is because there is an asymptomatic period of 3 weeks to 6 months during which antibodies are not detected in the blood serum of an HIV-infected person.

Thrombophlebitis on the arm after injection

Hello dear doctor. I had a blood clot on my arm after anesthesia. I went to the doctor, they said the danger had passed, everything was fine. Can you please tell me if there is a way to treat them? And if not, is it possible for me to train in the gym and put a lot of stress on my arm. Thank you in advance.

Lusine, Moscow, Russia, 33 years old

Sister

Complications after intramuscular injections

29.05.2012 |

The nurse should clearly understand what complications can be after intramuscular injections and how to avoid them. In the event of complications, the nurse must know the algorithm of medical care for the patient.

So, complications after intramuscular injections can be as follows.

Needle breakage

Infrequently, but it does occur. The reason is a strong muscle contraction with fear of the procedure, an unexpected start of the injection, and improper psychological preparation of the patient.

Help: keeping calm, calm the patient, assure him that everything will be fine. With the th and 2nd fingers of the left hand, press down on the tissues on both sides of the broken needle, squeezing it out in this way. With your right hand, take the tweezers, gently grab the tip of the fragment and remove it. The action is repeated several times. In case of unsuccessful attempts, urgently call a doctor through an intermediary, staying with the patient and reassuring him. In the future, follow all the instructions of the doctor.

Periosteal injuries

May occur when administering an intramuscular injection with an overly long needle to a lean patient. Assistance: referral to a surgeon and fulfillment of his appointments. Prevention: correlate the length of the needle with the size of the patient's subcutaneous fat at the site of the proposed injection.

Nerve trauma

Such complications after intramuscular injections can occur when the needle is inserted not into the upper-outer quadrant of the buttock, but, for example, into the lower-outer one. Nerve trunks can also be damaged when the drug is exposed directly to the nerve tissue. This happens if the drug is injected near the place where the nerve is located.

Help: referral to a doctor and explanation to the doctor of all the circumstances of the injection.

Infiltrates

Causes: rapid administration of the drug, low temperature of the injected drug, insufficient needle length, injections in places near a recent injection or with an old infiltrate.

Help. applying a semi-alcohol compress or the same with the addition of a 25% solution of magnesium sulfate, informing the attending physician.

Abscesses

Reasons: non-compliance with the rules of asepsis and antisepsis, injections into infiltrates, intramuscular injections with a short needle.

Help: urgent referral to a surgeon.

Hematomas

Causes: damage to blood vessels with a needle.

Assistance: referral to a doctor and fulfillment of his prescriptions.

embolism

Oil and suspension embolisms occur when a needle enters the lumen of a blood vessel, followed by the introduction of a medicinal substance. If the syringe is not sufficiently expelled, there is a risk of an air embolism if the entire contents of the syringe are injected into the blood vessel where the needle has entered.

Help: giving the patient a position lying on his side with a raised head end, an immediate call to the doctor through an intermediary.

Prevention: complete expulsion of air from the lumen of the syringe, "pulling" the piston when the needle is inserted with the intention of introducing oil or suspension solutions.

Thrombophlebitis and necrosis

Such complications after intramuscular injections are rare, but they do occur. Thrombophlebitis occurs when blood vessels are damaged, often multiple, followed by soft tissue necrosis.

Help: if the patient complains of severe pain and the presence of hematomas, immediately consult a surgeon.

HIV infection, parenteral hepatitis

Causes: a gross violation of the rules of asepsis and antisepsis when administering intramuscular injections, including the treatment of hands, pre-sterilization cleaning and sterilization of instruments.

Prevention: strict adherence to all existing regulations and sanitary standards during invasive manipulations.

allergic reactions

With the introduction of any drug in a patient, an allergic reaction can occur from hives to anaphylactic shock. The treatment room should be equipped with an anti-shock first aid kit and tools to help with respiratory arrest.

Knowing the possible complications after intramuscular injections, the nurse should make every possible effort to prevent them. And in the event of any complication, be ready to take the necessary actions on your part.

Intramuscular injection technique.avi

heal-cardio.ru

Tissue necrosis: causes, treatment:

Even in the modern world, anyone can face such a problem as tissue necrosis. This article is about this disease and will be discussed.

What it is

First of all, it is necessary to deal with the concepts themselves, which will be actively used in this article.

Necrosis is a process that does not have a reverse nature. With this disease, tissue cells or parts of organs gradually die off. It can even be said that this is the end result of the decay of tissues of a still living and functioning organism. Important: necrosis is also called gangrene (this is one of the subspecies of the disease). This disease develops exclusively in those tissues that have the prerequisites for death, i.e. in previously damaged ones.

The reasons

Be sure to say about why tissue necrosis can occur in a living organism. What are the prerequisites for the emergence of this terrible disease? So, speaking in general, gangrene begins to develop in those organs or tissues where blood circulation is disturbed. And the farther away a part of the body is from the main blood vessels, the more likely it is to become infected.

1. physical reasons. This may be the influence of low or high temperature, a gunshot wound, electric shock and even radiation.
2. Biological. The simplest organisms can cause tissue necrosis: viruses, bacteria.
3. Allergic. For example, in infectious-allergic diseases, fibroid necrosis may occur in some tissues.
4. Vascular. A heart attack is the same vascular necrosis. It is associated with impaired blood circulation in organs or tissues.
5. toxic causes. Various chemicals and toxins that damage body tissues can cause gangrene.
6. Trophoneurotic. In this case, tissue death is caused by non-healing ulcers, bedsores. The disease is associated with the innervation of tissues, as well as with a violation of blood microcirculation.

Tissue necrosis may occur due to certain diseases. So, the causes of the appearance of this disease can be diabetes mellitus. Also, damage to the spinal cord or large nerves can contribute to the occurrence of necrosis.

About the types of disease

Be sure to say that tissue necrosis can be classified. What can be this disease depending on the mechanism of action?

1. direct necrosis. It occurs as a result of injuries, poisoning with toxins, or due to the work of certain microorganisms.
2. Direct necrosis. It occurs indirectly, through such systems of the body as the cardiovascular or neuro-endocrine. It can be allergic, trophoneurotic and vascular necrosis.

In medical practice, there are two more types of this disease:

1. Colliquational necrosis. Together with tissue necrosis, their edema occurs.
2. coagulative necrosis. With this subspecies of the disease, along with tissue necrosis, their complete dehydration also occurs.

Symptoms

Is it possible to independently recognize tissue necrosis? Symptoms of this disease can be as follows:

1. Lack of sensitivity, tissue numbness.
2. Paleness of the skin (this may be the so-called "waxy" skin).
3. If you do not fight the previous symptom, the skin begins to turn blue at first, then turn green or turn black.
4. If the disease affects the lower limbs, then it becomes difficult for the patient to walk. Feet can also freeze even at high air temperatures.
5. There may be lameness in the legs, muscle twitching.
6. Also, ulcers often begin to appear that do not heal. It is with this symptom that gangrene begins.

Stages of the disease

Very scary in nature and the end result is a disease such as tissue necrosis (a photo of patients with such a disease is the first confirmation). However, it should be said that this disease takes place in several stages.

1. Paranecrosis. These changes are still reversible, if treated in time, the disease can be eliminated without any negative consequences for the body.
2. Necrobiosis. These changes are now irreversible. In this case, an important metabolism in the tissues is disrupted, which prevents the formation of new healthy cells.
3. Cell death.
4. Autolysis. This is the process of complete decomposition of tissues. It occurs under the action of enzymes that secrete dead cells.

coagulative necrosis

It most often affects those parts of the human body that are rich in proteins, but also poor in various body fluids. For example, it can be coagulative necrosis of liver cells (adrenal glands or spleen), where oxygen deficiency and inadequate blood circulation most often occur.

Subtypes of coagulative necrosis

There are several subspecies of the so-called "dry" necrosis:

1. Heart attack. This is vascular tissue necrosis. By the way, the most common disease.
2. Curdled, or caseous, necrosis. It occurs if a person has diseases such as leprosy, syphilis, tuberculosis. With this disease, a piece of dead tissue is found on the internal organs, it can crumble. If the patient is syphilitic, his areas of dead tissue will look like a whitish liquid (similar to cottage cheese).
3. Zenkerovsky, or waxy, necrosis. This subtype of the disease affects muscle tissue.
4. fibrinoid necrosis. This is the death of areas of connective tissue. The causes of its occurrence are most often autoimmune or allergic diseases.
5. Fat necrosis. It, in turn, is divided into enzymatic (most often occurs in diseases of the pancreas) and non-enzymatic fat necrosis (this is necrosis of adipose tissue that accumulates under the skin, and also exists in the mammary glands).
6. Gangrene.

A few words about gangrene

Be sure to want to say a few words about such a disease as gangrene. This is one of the subspecies of tissue necrosis. It affects areas of the body that are actively in contact with the external environment. Why is this disease singled out in a separate group? It's simple, often when the skin is affected by gangrene, its bacterial infection also occurs. And along with this, the disease undergoes secondary changes. Scientists distinguish between the following types of gangrene:

1. Dry. In this case, tissue necrosis occurs without the participation of pathogens. Occurs most often on the extremities of the patient. This may be atherosclerotic gangrene (occurs as a result of a disease such as vascular atherosclerosis); gangrene, which arose due to exposure to temperatures (burn or frostbite of the skin); gangrene that affects the fingers (vibration disease or Raynaud's disease), or gangrene that affects the skin during infectious eruptions (for example, during typhoid).
2. Wet gangrene. Occurs as a result of the attachment of a bacterial infection to the dead tissue. It develops most often in the internal organs. As a result of infection, an unpleasant odor often occurs. With this type of gangrene, lethal outcomes are possible.
3. Gas gangrene. Occurs after infection of the wound with anaerobic flora. As a result of the disease, a large area of ​​\u200b\u200btissue is infected, gas is formed. The main symptom: crackling under the fingers during palpation. It is worth mentioning that the percentage of deaths is also quite high.
4. Bedsores. This is the necrosis of individual sections of tissue under pressure. They occur most often in bedridden patients. In this case, nerves and blood vessels are compressed, blood circulation is disturbed and this disease occurs.

Aseptic necrosis

Aseptic necrosis develops as a result of a violation of the blood flow of the vessels that feed the head of the femur (this is the so-called "hinge" of the femur). It is worth saying that this disease affects men seven times more often than women. The age of the disease is young. It most often occurs in people between 20 and 45 years of age. An important point: aseptic necrosis is very similar to arthrosis of the hip joint in its symptoms. Therefore, these diseases are often confused. However, the course of these diseases is different. If arthrosis develops slowly, then necrosis affects a person rapidly. Main symptoms:

• Pain in the groin.
• Pain when walking.
• The appearance of lameness.
• Limited mobility of the affected leg.
• Atrophy of the thigh muscles.
• There can be both shortening and lengthening of the leg affected by necrosis.

As for treatment, its success depends entirely on the degree of the disease. How can you diagnose bone necrosis in the early stages of the manifestation of the disease:

1. Computed tomography - CT.
2. Magnetic resonance imaging - MRI.

It is impossible to detect bone necrosis at an early stage using x-rays. On x-ray, you can already see signs of aseptic necrosis. With the help of analyzes, it is also not possible to identify this disease at all. As for the treatment, in this case it will be aimed at improving blood circulation in the artery of the femoral head. Anti-inflammatory drugs and analgesics will also be effective. Surgical intervention for this type of disease is most often not required.

Necrosis and pregnancy

Sometimes pregnant women are diagnosed with "decidual tissue with necrosis." What does this mean? So, first of all, I would like to say that the most decidual tissue plays an important role at the time of implantation of a fertilized egg. It eliminates various damage to the walls of the uterus. And if she begins to die, this is a signal that the unborn child needs the supervision of qualified specialists. As a result of infection of this tissue, blood circulation will be disturbed, which can cause not only the decay of the decidual tissue, but also the rejection of the fetus.

Consequences of necrosis

Regardless of the cause of this disease in a patient (it will be tissue necrosis after an injection or infectious necrosis), the consequences of the disease can be very different (if timely competent treatment is not carried out). So, what could be the consequences of necrosis:

1. Scarring or replacement. In this case, necrotic masses are replaced by connective tissue.
2. Removal of dead cells. This is due to phagocytes and lysosomal enzymes of leukocytes.
3. Encapsulation. In this case, the focus of necrosis is, as it were, limited to the connective tissue.
4. Cell calcification. In this case, areas of dead tissue are impregnated with calcium salts.
5. Ossification. Here, in the dead areas, bone tissue begins to form.
6. cyst formation.
7. Melting tissue with pus. Often the result is sepsis. This is an unfavorable outcome of necrosis, when areas of dead tissue do not undergo autolysis.

Treatment

If the patient has tissue necrosis, treatment will depend on multiple factors. So, the causes of the disease, the type of disease, as well as the degree of tissue damage will be important. At the very beginning, I would like to say that the sooner necrosis is detected, the easier it will be for the patient to cope with the problem. The danger of the disease lies in the fact that deaths are possible here. That is why when the very first symptoms or even doubts about tissue death appear, one should seek medical help. Self-medication in this case can be life-threatening.

bedsores

If the patient has bedsores, the patient needs quality daily care. In this case, it is necessary:

1. Make sure that the patient's bed is clean, even, moderately hard. The sheet should not have any wrinkles.
2. The patient should be rotated as often as possible.
3. It is also important to rub bedsores as often as possible, massage the foci. Do everything to improve blood circulation in these affected areas.
4. Pressure sores should also be lubricated with salicylic or camphor alcohol.
5. Under the lower back or sacrum of the patient should be placed specially designed for such cases inflatable circles.

Dry necrosis

If the patient has the so-called dry tissue necrosis, the treatment will be carried out in two stages:

1. Drying of tissues, as well as preventing the subsequent development of infection.

• Around the area affected by necrosis, the skin will be treated with an antiseptic.
• Next, a bandage soaked in ethyl alcohol or drugs such as Boric acid and Chlorhexedine will be applied to the focus of the disease.
• It is also very important to dry the area affected by necrosis. This is done with the help of potassium permanganate (5% solution of potassium permanganate) or brilliant green.

1. The next stage is the excision of non-viable tissues. There may be cutting off of the foot, resection of the phalanx (it all depends on the degree of damage by necrosis).

A small conclusion: if the patient has necrosis, the treatment will be aimed primarily at restoring blood circulation in the affected areas. It will also be necessary to exclude the cause of tissue damage by necrosis. And, of course, the patient will be prescribed antibiotic therapy. This is necessary in order to avoid infection of dead tissues with a bacterial infection (after all, this is what can be fatal).

Wet necrosis

If the patient has wet necrosis of the skin or other tissue, then the treatment will depend on the degree of damage to the patient. At the very beginning, doctors will try to convert wet necrosis into dry necrosis (however, this is only possible in the early stages of the disease). If this fails, you will have to resort to surgical intervention.

Topical treatment for wet necrosis

What will doctors do in this case?

1. It is necessary to regularly wash the wound with a solution of hydrogen peroxide (3%).
2. The opening of the so-called pockets and streaks will be made, various methods of drainage are needed.
3. It is also important to apply antiseptic dressings. To do this, you can use drugs such as Furacilin, Chlorhexedine, Boric acid.
4. Also mandatory will be therapeutic immobilization (imposition of plaster splints).

General treatment for wet necrosis

If the patient has wet tissue necrosis (after surgery or for other reasons), then general treatment measures will be necessary.

1. Antibacterial therapy. In this case, the patient will be given antibiotics intravenously or intraarterially.
2. vascular therapy. Doctors will try to restore blood circulation in the tissues affected by necrosis.
3. Detoxification therapy. The forces of specialists will be aimed at preventing infection of living tissues that are close to the focus of necrosis.

Surgical intervention

If a patient has, for example, wet soft tissue necrosis, treatment may no longer help him. In this case, surgery will be required. Those. surgeons should start working with the patient. As mentioned above, at the very beginning of treatment, specialists will try to transfer wet necrosis to dry, this can take no more than a couple of days. If positive results are not observed, the patient will have to be sent for surgery. By the way, in this case, this is the only way to save the life of the patient.

1. Preoperative preparation. Here you will need antibiotic and infusion therapy.
2. Operation. Removal of necrosis within as yet unaltered and viable tissue. However, doctors know that pathogenic bacteria can already be found in healthy tissues. Therefore, the so-called "high" amputation is most often welcomed, when part of healthy tissues is excised along with the affected focus.
3. postoperative period. If the patient's skin necrosis ended with an operation and removal of a part of the limbs, then not only medical support of the patient for some time after the operation, but also psychological support will be required.

Folk remedies

As mentioned above, such a disease as tissue necrosis is quite terrible and dangerous (photos of patients affected by this disease are another confirmation of this). In this case, it is best to resort to medical help, since only qualified specialists can help to cope with the problem. However, in this case, traditional medicine often becomes useful. But it is best to be treated in this way only with the permission of a doctor or in extreme situations when it is impossible to get qualified medical help.

1. If the patient has such a problem as bedsores, they can be dealt with in the following ways. So, you need to lubricate the affected areas with sea buckthorn oil. You can make lotions from rosehip oil (all this is sold in a pharmacy).
2. Ointment from bedsores. To prepare it, you need to take chopped oak bark (two parts), black poplar buds (1 part) and butter (6-7 parts). The ingredients are mixed, the night is kept warm, after which everything is boiled and filtered. After that, the ointment is ready for use.
3. Ointment for necrosis. To prepare it, you need to mix a tablespoon of lard with one teaspoon of slaked lime and the same amount of ash obtained after burning oak bark. This mixture is applied to the wound, tied with a bandage, left overnight. Everything must be removed in the morning. You need to do this for three nights in a row.
4. Treatment of soft tissue skin necrosis can be carried out using herbal decoction. To prepare it, you need to pour two kilograms of ordinary chestnut fruits with water so that the ingredients are completely covered. Everything is boiled for about 15 minutes. After that, the water is drained into a jar, and the chestnuts are filled with fresh water. The procedure is repeated one more time. After that, the resulting liquids are mixed and simmered over low heat until two liters of liquid remain. Next, you need to take half a liter of decoction, add 5 liters of cold water there and make baths. The procedures should be repeated daily until the problem disappears.

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Post-injection abscesses, infiltrates

Hello. Did you have injections? Yes, yes, injections in the buttock, in the shoulder, under the shoulder blade, intravenous. It seems that everyone did. But did you have any complications after these injections (injections) in the form of "bumps", seals, abscesses? We believe there have been. Not everyone, of course, but some have. And how did you deal with this disease? Yes, who, probably. Is not it? Whoever advises, then they did. Let's talk about this topic.

We will take specific complications after an injection (injection) and analyze them from a practical point of view. Let's talk about how to try to prevent these complications, and if they occur, how to properly treat them. As a rule, injections (injections) are carried out in clinics, hospitals, at home. The main ones are intradermal, subcutaneous, intramuscular, intravenous.

Intradermal injections are usually carried out in order to test the tolerance (or intolerance) of a particular drug (for example, an antibiotic, vaccine, etc.). Complications after them do not occur.

Here, one should not confuse the true complication after an injection from various reactions of the body, which manifest themselves in the form of all kinds of allergic reactions - redness, blistering, itching, fever, and even the formation of an infiltrate at the injection site within a day after the injection. These reactions stop (pass) after taking antihistamines such as diphenhydramine, suprastin, tavegil, etc.

Subcutaneous injections (shots) are usually made in the middle and upper third of the shoulder, under the shoulder blade, under the skin of the abdomen. The drug is injected directly into the subcutaneous fat. An injection (injection) is done with a sterile syringe, the length of the needle ranges from 1.5 to 4-5 cm. Not all drugs can be injected subcutaneously, but only those that are allowed by the instructions for using this medication. Therefore, carefully read it (instructions).

Injection into the upper outer quadrant of the buttock.

Places for intramuscular injections are: the upper outer quadrants of the gluteal regions, the shoulder - the region of the deltoid muscle, the anterior surface of the thighs (usually in the upper and middle thirds). The injection (prick) needle must be at least 5 cm long. This is especially true for overweight people. It is desirable to administer the drug slowly.

Intravenous preparations are made that are allowed by the instructions. The drug must necessarily be administered slowly, unless circumstances require it. The injection sites are the region of the cubital fossa, sometimes the back of the hand, and even - do not be surprised - the back of the feet. In cases where they can’t find a vein in any way, the doctor performs catheterization of the subclavian vein under local anesthesia. The catheter is sutured to the skin. In some patients, especially those with deformity of the chest and spine, the doctor fails to place a catheter in the subclavian vein. What to do then? There is another way, this is venesection. What it is? This is a mini-surgery that is performed in the cubital fossa. In this area, a skin incision is made and a vein is isolated in the subcutaneous fat layer, incised, and a PVC catheter is inserted into its lumen. The skin is sutured.

Various catheters for intravenous infusion.

Recently, the method of setting a peripheral catheter has become "fashionable", that is, a soft catheter is inserted into the vein, which is fixed to the skin with adhesive tape. The advantage of this method is that it is not necessary to repeatedly make injections (injections) into a vein each time, they are made into a catheter. Another advantage of this method is that the patient can bend the arm at the elbow without fear that something wrong will happen. From frequent traumatization of the vein with a needle, complications can occur, which we will discuss below.

So, injections (injections) are prescribed for you. Many believe that everyone can make an injection, especially in a muscle. In principle, yes, but it would still be better if a medical professional (preferably with experience) gives the injection.

What is needed for that? The skin at the injection (prick) site should be treated with a sterile material with 70% alcohol (from 96% you will get a skin burn). The person making the injection should preferably be wearing sterile gloves, the syringe is disposable. If gloves are not available, hands should be thoroughly washed with soap and water and treated with alcohol or other approved product. Before opening the ampoule with the drug (after sawing), treat with alcohol (the very place of the file on the neck of the ampoule).

Well, now let's talk about what complications can occur at the injection site.

Immediately after an intramuscular injection, pain may occur (this depends on the composition of the drug itself and the speed of its administration), which disappears after a short time. Immediately after the injection, it is advisable to apply a warm heating pad or other dry heat to this place, which contributes to the expansion of blood vessels and a more enhanced penetration of the drug into the bloodstream.

Redness on the left buttock

Sometimes, within the next few days (4-7-10 days), thickening and infiltration of tissues may occur at the injection site. This formation is sometimes referred to as "bumps" by patients. At this stage, a person should definitely see a doctor, preferably a surgeon who can correctly assess the situation.

The doctor, in order to exclude abscess formation, can refer the patient to an ultrasound of the infiltrate or puncture it. If pus is found, an abscess is opened under local anesthesia or anesthesia.

There is already clearly formed abscess

If the infiltrate is without suppuration, then the use of antibiotics (in tablets or intravenously), physiotherapy for infiltration is indicated. Many patients are helped by compresses of rye bread with honey, vodka compresses or compresses with Vishnevsky's ointment.

Sometimes, after an intravenous injection, the drug does not enter the vein, but under the skin. This is manifested by pain under the needle, a burning sensation, swelling appears under the skin. As a rule, this situation is noticed immediately and does not require any help (the drug will then “resolve itself”). A half-alcohol or vodka compress can be applied to the site of such an injection.

If calcium chloride gets under the skin, then you should immediately prick this place with a 0.25% solution of novocaine (this will reduce the concentration of calcium chloride in the surrounding tissues) and apply one of the above compresses.

There is redness around the irregularly shaped wound, and necrosis and purulent plaque in the center.

If a lot of the drug got under the skin, then tissue necrosis occurs. Surgeons have to treat such patients. It should be noted right away that this is not easy, both for the patient and for the doctor. Black skin necrosis, as a rule, is deep, it has to be excised, sometimes more than once. Wounds heal slowly with the formation of a rough scar.

A red stripe is visible on the forearm - this is phlebitis.

Sometimes, after intravenous administration of certain drugs, hyperemia and induration along the vein, pain in it appear almost immediately or within a few days. This is the so-called phlebitis or inflammation of the walls of the vein. Even thrombophlebitis can occur when blood clots form in the lumen of an inflamed vessel. A red stripe is visible on the forearm - this is phlebitis. Usually in such cases, compresses with Vishnevsky ointment, heparin ointment, drugs that improve microcirculation, antibiotics, low molecular weight heparins are used.

There are cases when patients apply for "bumps" on the buttocks, which persist after injections (injections) for several months or even years. What can be advised in this situation? It is necessary to conduct an examination and study of these formations and differentiate them from benign or malignant tumors. In most of these cases, conservative treatment of "bumps" does not give a positive effect, and these formations have to be excised, although very rarely.

What can lead to the development of post-injection complications and what are their causes?

1. In most cases, this is a violation of the rules of asepsis and antisepsis, i.e., the infection enters the tissues through poorly treated skin, hands, an infected syringe, etc.
2. There are a number of drugs, such as analgin, diclofenac, ketorol, magnesium sulfate (magnesia), etc., which themselves can cause aseptic inflammation, which can turn into suppuration if a secondary infection joins.
3. If the drug intended for intramuscular injection enters the subcutaneous fat, where the "absorption" of the drug into the blood is slower. As a result, a secondary infection may rejoin.
4. Weakened immunity in oncological patients suffering from diabetes mellitus, etc.
5. When the needle enters a sufficiently large vessel, a hematoma is formed (in the muscles or adipose tissue), which may not have time to “resolve”, resulting in its suppuration.

Some readers may ask, what does injections and surgery have to do with it? But the fact is that surgeons are involved in the treatment of complications associated with injections. And we want them, complications, to be less, which is what we wish you.

It is necessary not only to remember about gastric bleeding, but also to know about them.

Foreign body of the stomach. case from practice

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Method for preventing post-injection necrosis

The invention relates to medicine. Not later than 6 minutes after the injection of diclofenac, a solution of 10% calcium gluconate is injected into the area of ​​the drug infiltrate. The volume of the injected solution is 1/3 of the injected volume of diclofenac. After the introduction of the solution, a half-alcohol compress is applied to the affected area. The method increases the efficiency of preventing the development of necrosis due to the timely inactivation of the components of the diclofenac sodium solution.

The invention relates to medicine, in particular to clinical pharmacology, and can be used for intramuscular injections of diclofenac preparations.

A known method of preventing post-injection necrosis caused by erroneous injection of calcium chloride solution under the skin by leaving the needle at the injection site, detaching the syringe from it, introducing through it into the tissue with a second syringe, initially 5-10 ml of saline, and then 10 ml of 0.25% solution novocaine, after which a half-alcohol compress is applied to the affected area (Mylnikova I.S. Ward nurse. M .: Grand, 1998, p. 153).

The disadvantage of this method is the low efficiency of tissue protection during intramuscular injections of diclofenac preparations that can have a denaturing effect. The fact is that the introduction into the area of ​​​​post-injection drug infiltrate caused by the injection of the drug diclofenac (75 mg of diclofenac sodium in 3 ml of solution), initially 5-10 ml of saline, and then an additional 10 ml of a solution of 0.25% novocaine, causes additional tissue damage , due to the hydrodynamic effect created by an excessively large volume (the total volume of injected solutions is 15-20 ml) of drugs that additionally infiltrate the tissue. In addition, saline solution (solution of 0.9% sodium chloride) and a solution of 0.25% novocaine do not enter into a chemical reaction with the components of diclofenac, do not inactivate them and therefore do not eliminate their denaturing effect on proteins and protein-lipid complexes of tissues. In this regard, the introduction of significant volumes of saline and a solution of 0.25% novocaine, which are not diclofenac antidotes, into the area of ​​​​medical infiltrate created by injection of diclofenac does not inactivate it, therefore, does not prevent the damaging effect on tissues and the development of post-injection necrosis.

In addition, the disadvantage of this method is its belated application, since only the urgent introduction of antidotes that inactivate denaturing agents can inactivate them in a timely manner, namely, before the expiration of their safe presence in the tissues. The fact is that the denaturing agents of diclofenac preparations for injection do not have an instant damaging effect, such as ethyl alcohol 96%, which instantly cauterizes tissues. Post-injection tissue necrosis is due to the presence of alcohols in diclofenac preparations, the concentration of which can reach 24% in some diclofenac preparations (20% dihydric aliphatic alcohol propylene glycol and 4% benzyl alcohol). At the same time, the degree and nature of post-injection tissue damage from diclofenac preparations is directly dependent on the duration of their exposure to them in the first period after injection. The fact is that in the first few minutes of their exposure, they do not cause excessive changes in the structure of tissue proteins, and it is reversible. With an increase in the duration of exposure to 6 minutes, changes in some tissues, such as cellulose, may become excessive, and the period of reversible changes in them may be replaced by a period of irreversible damage, after which tissue necrosis becomes inevitable regardless of the introduction of antidotes or other drugs.

The purpose of the invention is to increase the efficiency and safety of tissue protection from acute post-injection damage by diclofenac preparations.

The essence of the proposed method for preventing post-injection tissue necrosis caused by the administration of diclofenac preparations, which includes leaving the needle at the injection site, detaching the syringe from it, introducing a drug solution through it with a second syringe and then applying a half-alcohol compress to the affected area, lies in the fact that no later than 6 minutes, a solution of 10% calcium gluconate for injection is used as a medicine in a volume of 1/3 of the volume of the administered diclofenac preparation.

In the proposed method, due to the urgent (no later than 6 minutes after the injection of the drug diclofenac) injection of the drug solution, it is possible to more effectively reduce the concentration of all components of diclofenac in the tissues due to the timeliness of their dilution. The urgent decrease in the concentration of all components of the medicinal product in the tissues achieved by dilution during the period of reversible changes in them reduces the degree of the damaging effect of denaturing agents because it is directly proportional to their concentration. The introduction of a solution of 10% calcium gluconate for injection into the post-injection drug infiltrate formed by the diclofenac drug in a volume that is one third of the volume of the injected diclofenac drug provides, on the one hand, complete and immediate inactivation of propylene glycol and diclofenac sodium inside the drug infiltrate in the tissues, and on the other hand on the other hand, it excludes the introduction of excessively large volumes of calcium gluconate solution, which increase the severity and duration of post-injection tissue edema.

The use of calcium gluconate solution contributes to the safe interaction of calcium ions with propylene glycol and sodium diclofenac in tissues, since in case of incomplete inactivation of calcium gluconate itself, it does not cause post-injection tissue damage in the dose used.

Due to the interaction of calcium ions in a solution of 10% calcium gluconate with propylene glycol, a salt of calcium propylene glycolate is formed, which inactivates propylene glycol as an alcohol and leads to its disappearance in the infiltrate area, and therefore the process of its denaturing effect on tissue protein structures stops. Due to the interaction of calcium ions with sodium diclofenac, an insoluble calcium diclofenac salt is formed, which also inactivates this compound. As a result of physical and chemical interaction, the damage process stops at the stage of reversible changes, the transformation of which into irreversible damage does not occur.

Example 1 Patient V. was administered daily intramuscular injections of 3 ml of "Diclogen in ampoules of 75 mg/3 ml for injection" manufactured by the Indian manufacturer AGIO Pharmaceuticals LTD (Series DB-5042) in the outpatient setting. However, after the first injection of this drug of diclofenac into the right upper outer part of the gluteal muscle, the patient felt a strong burning pain in the depths of the soft tissues of the injection area. In connection with the suspicion of developing post-injection tissue damage, the needle was left at the injection site, the syringe was disconnected from it, and 5 ml of saline (isotonic solution of 0.9% sodium chloride) was injected through it into the area of ​​the drug infiltrate with a second syringe. The feeling of tearing pain in the patient did not decrease for 10 minutes, so an additional 10 ml of a 0.25% novocaine solution was injected through the same injection needle with a syringe. The feeling of pain in the gluteal muscle of the patient gradually disappeared after 2 minutes, after which a half-alcohol compress was applied to the affected area. The next day, in the area of ​​injection, the presence of developing post-injection inflammation was revealed.

In this regard, another injection of diclofenac was made in the upper outer square of the left gluteal muscle. For injection, the same "Diclogen in 75 mg/3 ml injection ampoules" manufactured by the Indian manufacturer AGIO Pharmaceuticals LTD (Series DB-5042) was used. To prevent post-injection necrosis, immediately after intramuscular injection of 3 ml of diclofenac, the injection needle was left at the injection site, the syringe was disconnected from it, and after 30 seconds, 1 ml of a solution of 10% calcium gluconate was injected through it into the area of ​​the drug infiltrate with a second syringe, after which it was injected into the affected area a half-alcohol compress was applied. The burning sensation in the depths of the soft tissues of the injection area gradually disappeared, the post-injection infiltrate in the soft tissues subsequently was not accompanied by the phenomena of true inflammation and gradually resolved without a trace.

At the same time, post-injection inflammation in the right gluteal muscle resulted in the development of an abscess, for which surgical treatment was applied.

Thus, the proposed method increases the efficiency and safety of tissue protection from acute post-injection damage by diclofenac preparations due to the urgent use of calcium gluconate solution as a chemical antidote.

A method for preventing post-injection tissue necrosis caused by the administration of diclofenac preparations, which includes leaving the needle at the injection site, detaching the syringe from it, introducing a drug solution through it with a second syringe and then applying a half-alcohol compress to the affected area, characterized in that no later than 6 minutes as drugs use a solution of 10% calcium gluconate for injection in a volume of 1/3 of the volume of the administered diclofenac preparation.

In this article, we will look at several popular alternative medicine potions.

Gangrene is necrosis, the death of part of the tissues (skin and soft) due to the onset of oxygen starvation of cells in a certain area of ​​the body. Most often, gangrene develops in the most remote areas of the heart, that is, on the lower extremities (toes and heels). A strong manifestation can result in amputation with disability, in the worst cases, gangrene will cause extensive inflammation, intoxication of the body, and death. So what folk recipes can treat necrotic diseases at home?

Before applying this or that method of alternative treatment, learn everything about it. It is not superfluous to consult with a professional doctor regarding the possibility of taking such therapy.

Hirudotherapy

For many centuries, man has learned to use the gifts of nature for good. Gangrene in the old days was called "Anton's fire" and was associated with blood poisoning. Ordinary medical leeches have been and remain a very effective way to purify the blood. "Little sorceresses" work real miracles. It has been proven that the saliva of leeches contains biologically active substances with various beneficial properties:

• anti-inflammatory action;
• antibacterial;
• blood-purifying.

They tell one story. A certain man, on whose legs ulcers were gaping, gangrene of the limbs was about to begin, while fishing, went into the water up to his knees. When he got ashore, his legs were covered with leeches. He was frightened and began to frantically tear them off. And after a few days, ulcerative abscesses almost completely disappeared from him, puffiness subsided. After some time, he fully recovered.

You can't soar your legs

One of the symptoms of gangrene is a feeling of cold feet. By the way, severe frostbite can also become one of the causes of necrosis. So, in no case should you soar your legs. This will further provoke thrombosis of blood vessels.

With frostbite, you can not soar legs

Tonic baths are applicable, but with a water temperature of not more than 40 degrees Celsius. It is recommended to add to the water, for example, mustard powder (15-20 g per 2 liters of liquid) or sea salt (dessert spoon per 1 liter of liquid). During the procedure, you need to rub your feet with smooth massaging movements, especially your fingers.

And the feet should be washed daily in cold water, after intensively rubbing with a towel. These procedures stimulate blood circulation.

Experts will definitely advise you not to wear narrow, uncomfortable shoes and models with heels.

Ointments prepared by hand

It is more effective to treat gangrene with conservative methods, but it is possible to prevent the disease in an unconventional way. Although there were cases of getting rid of gangrene with "grandmother's drugs."

The main reason for the appearance of dead tissues is oxygen starvation of cells with their subsequent destruction. So, it is necessary to contribute to the improvement of the metabolic processes of the lower extremities.

1. A multicomponent ointment is considered miraculous. In equal proportions (50 grams) are mixed:

• rosin;
• wax;
• rendered animal fat (unsalted);
• vegetable oil;
• laundry soap.

The ingredients are brought together in one container, which is placed on the fire. Stirring constantly, the mass is brought to a boil. Cooling down. To the mixture at the end you need to add chopped onions, garlic, aloe pulp.

Ready ointment to be stored in the refrigerator. Before use, it is recommended to warm it in a water bath. By daily rubbing the affected area with this remedy, you stimulate the removal of infection from the tissues, the healing of wounds, and the restoration of the skin (in one patient, a new nail even grew on the sore finger).

1. Healing homemade ointments are made on the basis of mummy. The resin can be mixed with the usual factory cream or glycerin, let it brew for a day. Apply to affected tissue without rubbing.

Mumiyo-based ointment is applied to the affected tissues without rubbing

1. Wax (no more than a matchbox), heat 200 ml of vegetable oil in a water bath. When the mixture begins to boil, add half of the boiled chicken yolk, a pinch at a time. Strain the mixture and chill. Before applying, the ointment must be warmed up a little.

Herbs and spices

There are a huge number of plants that are called "medicinal". Many of them are able to treat many diseases, even gangrene of the leg. Tinctures, decoctions, compresses are prepared from herbs. Some drugs are taken orally, some are taken externally.

1. Lily oil. During flowering, white lily flowers, along with leaves and stems, are placed in a glass container, poured with non-deodorized sunflower oil. Infused for two weeks in the cool out of the light. Then the oil can be drained, and the plant can be poured with another portion of fat. The resulting oil infusion is applied externally.
2. The unique spice of cloves can be used externally and internally (as, in fact, seasoning in food). It is possible to treat manifestations of gangrene externally with a dressing soaked in clove oil. The pungency contained in the seed helps to increase blood flow, thereby stimulating metabolic processes.
3. Sorrel juice can be drunk daily, three times a day is enough. Fresh sorrel leaves are applied to the sore spot in the manner of a plaster.
4. You can try to treat gangrene with lotions based on a decoction of rosemary. A preventive effect is provided by taking a liqueur of rosemary and spool (mix a few grams with water and drink).

Effective in their use are folk remedies from burdock, nettle, sea buckthorn, needles, cudweed ... even fly agaric!

Massage

Rubbing, stroking, kneading, pinching and the like - massage actions are indispensable when exposed to blood vessels. Ten to fifteen minutes a day to spend on the procedure, which, by the way, is easy to perform on your own.

Extraordinary Ingredients

1. The ancient Tibetan way to treat necrosis is as follows:

• the affected tissues are cut and cleaned of pus;
• then they are smeared with fresh animal blood (the first use of this method was yak blood);
• dressing is done (for some reason, with a non-sterile bandage).

This procedure is repeated for several days in a row. After that, the infection is gone.

1. And here is another "creepy" way. Tie a fresh piece of lamb or beef liver for several hours to the site of tissue damage. Wait until a kind of bubbles-sores form on the skin. Open the abscesses with a sharp, calcined needle and reattach a piece of the animal's bloodied liver. This procedure is repeated several times. Animal entrails must interact with open wounds.

It is impossible to enumerate all the folk remedies that healers of antiquity and modern healers tried to treat gangrene of the legs.

However, do not rush to look for a "home" recipe if you suspect gangrene. Only a specialist will clarify all the pros and cons. Self-medication here can turn into dire consequences.

With gangrene of the limb, in particular, I used the so-called Garyaev's Poultice ZhKIM, which I did not really understand, but after a week of application in the form of a compress

the leg pains went away and most importantly, the black dead skin and purulent wounds began to heal and, in the end, only scars on the leg remained. So, grandparents who pass on their ability to treat folk remedies for gangrene of the legs are often the only and affordable way without reproaching medicine, if there were no health problems, there would be no healers.

The information on the site is provided for informational purposes only and is not a guide to action. Do not self-medicate. Consult with your physician.

Treatment of necrosis

Treatment of necrosis with folk remedies

Life is beautiful if a person is physically healthy. Any diseases bring grief, and the fight against them requires patience and a reasonable approach, only then is it possible to restore normal life. Necrosis is a severe disease that affects people of all ages. There are many forms of this disease, since ancient times people have learned to treat it.

Folk remedies in the treatment of necrosis are strong and reliable, but still, in most cases, first of all, you need to consult a doctor. When treating necrosis, you should choose the most effective methods, because this insidious pathology can lead to death. There is excellent evidence of recovery as a result of the use of wonderful folk remedies, with the help of which it was possible to avoid the amputation of various parts of the body in hundreds of people.

Treatment of necrosis with ointments

Combine 200 g of unrefined sunflower oil, 10 g of bleach, boil over a fire, cool and lubricate the wounds with a warm mixture until they are completely healed.

There are examples of recovery with special ointments. A woman who had been suffering from diabetes for 20 years developed gangrene of her leg, which was refused to be treated in the hospital, because it was believed that during the operation her heart might not be able to withstand, one healer grandmother cured with an ointment. The treatment lasted a month, the ointment was constantly applied, the danger was over.

Ointment recipe number 1: put in a saucepan 50 gr. - rosin, wax, honey, lard, laundry soap, sunflower oil. Mix everything, boil. In the cooled mass add 50 gr. chopped onion, garlic, and aloe leaf. Before use, the ointment must be heated in a water bath.

For a non-healing wound (gangrene), you can prepare a few more ointment recipes.

Recipe for ointment No. 2: combine 80 g of honey, 20 g of fish oil, 3 g of xeroform, mix until smooth. Apply to a gauze napkin and apply as a compress to a place affected by gangrene. Change the bandage every 2-3 days. Continue treatment for 2-3 weeks.

Ointment recipe number 3: mix 1 tbsp. a spoonful of lard, 1 tsp. slaked lime and oak bark ash, apply in the evening with a bandage on a sore spot, and remove in the morning. So three nights in a row.

Ointment recipe No. 4: mix 250 g of softened, unsalted pork fat, 2 g of streptomycin sulfate, 9 g of streptocide, 2 tbsp. l. boric acid, 1 tsp. salicylic acid. Apply a napkin with ointment to the wound at night, remove it in the morning, washing the wound with hydrogen peroxide each time. Store the ointment in a glass jar in a cool place. With the formation of gangrene in patients with diabetes, to restore blood circulation, it is recommended to use cakes from minced comfrey root in a meat grinder, 1 tsp. internal fat of chicken or rabbit, 2-3 tbsp. milk. They need to be heated to the maximum tolerable temperature and ready-made cakes are applied to sore spots. Wrap with a scarf and leave overnight. Each time you need to prepare a new mixture. Gangrene will soon recede.

Recipe for ointment No. 5: 40 g of fish oil, 160 g of honey, 8 g of Xeroform, 10 g of Anestezin. After a half-hour bath, rub this ointment into the affected area with necrosis, apply paper, fix and leave for a day. Continue treatment until recovery.

Maybe someone will benefit from the experience of treating gangrene, gained during the Second World War by a soldier who lay in the snow, being wounded and received frostbite. When gangrene began, everything went to the fact that the legs had to be amputated. The nurse helped, she undertook to treat the patient with carrot juice.

The treatment lasted 3-4 months, the disease subsided. The action of carrot juice also in another case showed a therapeutic effect in the elimination of black spots that appeared on the pads of the fingers in a person 12 years after the amputation of the lower extremities. Juice should be drunk in a glass once a day.

Treatment of necrosis with black bread

Fresh rye bread must be well salted. Chew thoroughly and put the resulting mixture on the area affected by necrosis. The beneficial substances of bread and saliva enzymes inexplicably work wonders.

History knows a good recipe by the American naturopath Charles McFerrin, he recommends treating gangrene with lamb or beef liver.

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Treatment of liver necrosis

A piece of the liver, extracted from a fresh carcass of an animal, without washing, is applied to the gangrene lesion.

Withstand an hour or two, pimples or abscesses should form under the liver, which must be pierced with a sterilized needle. Then again repeat the imposition of bloody pieces of the liver and pierce the abscesses with a needle. After such a seemingly strange treatment, according to Ferrin, a period of remission sets in, and doctors who advised removing the damaged part of the body are amazed when they re-examine the already recovered patient.

Academician I.K. liked to talk about the miraculous recovery of one Tibetan resident. Roerich to students during his lectures. While hunting, the Tibetan injured his hand, which caused blood poisoning, and the skin on the hand darkened. It is known that Tibetan lamas are folk healers, and therefore the wounded man turned to one of the lamas for help. An incision was made with an ordinary knife at the place of blackening, the wound, cleansed of coagulated blood, was abundantly smeared with fresh yak blood, and applied. This procedure was performed 4 times and the disease receded.

Treatment of necrosis with herbal decoction

Folk remedies for the treatment of necrosis include most natural products and components that help eliminate a terrible disease. Excellent results of treatment are shown by the use of decoctions from plants, which are used for baths.

Decoction recipe: pour 2 kg of chestnut fruit, cover with water and boil for 15 minutes. Pour the finished broth into a jar, and pour the same chestnuts with fresh water, and boil again. Then combine both decoctions and boil until 2 liters of liquid remain. In 0.5 liters of the resulting broth, add 5 liters of cold water, heat it up and take warm baths. Repeat daily.

The healing effects of herbs have helped many to forget for a long time about the torment of necrosis.

An interesting story of healing happened to one woman.

After she was diagnosed with gangrene of the big toes of both legs, she almost lost them. The doctors managed to save her, but after the hospital, under the nails, everything, but sometimes pockets of suppuration appeared. The use of prickly tartar herb made it possible to get rid of such processes. Her nails have cleared up and for several years in a row she has been doing well with her health.

Treatment of necrosis with prickly tartar

Pour half a liter incomplete jar of crushed flowers, stems and leaves of the tatarnik with 3 liters of boiling water. Leave for a minute, strain. To 1.5 liters of the finished broth, add the same amount of boiled water cooled to the temperature of fresh milk and take foot baths for 30 minutes.

Needle necrosis treatment

The cut tops of the branches of needles (10-12 cm) are finely chopped, pour 0.5 liters of water and boil for 10 minutes. After this, the broth must be wrapped and insisted all night. Strained broth to drink during the day instead of water. You can add a handful of onion peel and 5 crushed rose hips.

Necrosis appears suddenly and progresses rapidly, early treatment helps to stop putrefactive processes. Sometimes a case helps to cure the disease. Such an episode from the life of his grandfather was told by his granddaughter. During carpentry, my grandfather injured his leg, and after a while gangrene formed, the doctors were unanimous in the opinion that the leg should be amputated. They decided to refuse the operation, and upon returning home from unbearable pain, the curdled milk that caught my grandfather's eyes was used as a remedy. Applying sour milk to the wound, he felt relief. After a course of such procedures, the leg was saved.

Treatment of necrosis with lily oil

Cut off during the flowering period, five stems of a white lily, together with the root, can be cut and folded into a half-liter jar. Pour in unrefined vegetable oil. Keep for two weeks in a dark cool place. Apply a bandage moistened with oil to the necrotic area (leg, arm, fingers, etc.), fixing it with parchment or cellophane. The bandage should be changed every 3 hours, washing the wound with a manganese solution.

After suffering necrosis, having experienced the complexity of the struggle for life, people share miraculous recipes with those who are waiting for help.

Ficus helps to cope with the disease, a beautiful plant has long been known for its properties.

The liver, the largest unpaired organ, provides homeostasis of the body, participates in the implementation of most of its metabolic processes. The functions of the liver are varied. The organ plays an important role in metabolism, digestion, cleansing the blood of toxic substances coming from the gastrointestinal tract and entering the body from the environment.

The term "tumor necrosis factor - alpha" appeared in 1975 (Kakhektin). TNF or cachectin is a non-glycosylated protein capable of exerting a cytotoxic effect on a tumor cell. The name of the protein TNF-alpha means its antitumor activity associated with hemorrhagic necrosis. May cause hemorrhagic necrosis of some tumor cells, but does not damage when.

Caseous necrosis is a type of coagulative necrosis. The tissue affected by this type of necrosis is converted into a soft, white proteinaceous mass similar to cottage cheese (casein). Casey necrosis can be caused by tuberculosis, syphilis, and a special type of fungus.

Acute myocardial infarction contributes to the development of necrosis of a portion of the heart muscle. This occurs as a result of acute coronary insufficiency caused by a sudden cessation of blood flow through the coronary artery or insufficient oxygen and nutrients consumed by the myocardium.

The information on the site is intended for familiarization and does not call for self-treatment, a doctor's consultation is required!

Journal headings

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:

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

The affected cells die.

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:

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.

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.

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.

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

In the treatment of any type of necrosis, several important points are taken into account:

• Variety, form of necrosis.
• The stage of the disease.
• Presence/absence of comorbidities.

With necrosis, which is localized on the skin, doctors carry out local procedures + general treatment.

If a patient is diagnosed with dry necrosis, with superficial lesions, therapeutic measures will include:

Procedures aimed at drying damaged tissues:

• The use of antiseptic drugs.
• Treatment of affected tissues with a solution of brilliant green/potassium permanganate.
• The use of dressings soaked in ethyl alcohol, chlorhexidine.

Procedures aimed at the elimination of dead cells. During this manipulation (necrectomy), a non-functional area is resected.

The goal of the general treatment of dry necrosis is to eliminate the cause that provoked the appearance of this disease. For this purpose, medications, surgical treatment to restore blood circulation can be used.

If a patient has wet necrosis, with superficial lesions, therapeutic measures to eliminate the pathology will include:

• Treatment of the wound surface with the use of hydrogen peroxide.
• Drainage of edema, pockets.
• The use of bandages that are impregnated with various antiseptics.
• The use of plaster tires.

• Antibiotic therapy.
• The use of medications that will help prevent intoxication of the body.
• The use of drugs that help strengthen the walls of blood vessels.

Use if the measures taken to eliminate wet necrosis have not yielded results. Often, the waiting period for results with general/local treatment of wet necrosis is 2 days. If during the specified period no positive transformations have occurred, the operation is performed. Any unreasonable delay can cost the patient his life.

Diagnosis of necrosis in a patient, which is localized in the internal organs, provides for a complex of therapeutic measures:

Assign to relieve pain. These medicines help the muscles relax, which has a positive effect on the restoration of blood flow. Popular drugs in this category are nimulide, piroxicam, ketoprofen, diclofenac.

It is used as a method of improving blood circulation, to eliminate spasm of small vessels. Restrictions in terms of taking such drugs relate to cases where there has been a stroke, myocardial infarction. The list of popular vasodilators includes: trental, teonikol.

• Medications that promote the restoration of bone tissue (with sequesters).

These medicines include those that are rich in vitamin D, calcitonins.

Assign in cases where there is a place to be necrosis of bone tissue. Preparations of this group contribute to the restoration of cartilage tissue, they need to be drunk for a long period. Use these drugs in the later stages of the disease.

The beneficial effect when using such leeches is achieved due to the enzymes that they release into the patient's body due to suction. Through these enzymes, blood clots, which are the main cause of necrosis, dissolve, blood circulation is restored. It is not recommended to use more than 2 courses of such treatment per year.

Useful in combination with other methods of treatment. Massage should not be rough, cause pain, discomfort. Improper massage can cause the condition to worsen. This treatment procedure has some contraindications, which must be taken into account.

In combination with other therapeutic measures, they help restore normal blood circulation, reduce pain, and improve well-being. Ideal for necrosis of the hip joint. If the patient has complaints of frequent bleeding, regular fatigue, in his medical history there is information about a recent myocardial infarction, stroke, laser therapy cannot be applied.

It is effective in cases where the disease in question was caused by the infringement of the joint. Otherwise, this type of therapy is not used as a treatment for necrosis.

In the presence of bone tissue necrosis, without this medical procedure it is impossible to achieve full success: bone tissue necrosis provokes muscle atrophy. A set of exercises for such gymnastics must be approved by a doctor - active dynamic exercises for necrosis are unacceptable.

It is necessary in cases where conservative treatment has not given positive results. If non-surgical procedures are performed regularly by the patient, treatment was started in the early stages of necrosis, it will be possible to judge the quality of the measures taken in a few months.

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:

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. Necessary 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:

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).

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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Skin necrosis

In our age of technological and medical progress, a person is still forced to face necrosis of the skin. Skin necrosis has another name - gangrene. Necrosis is the partial necrosis of the skin and nearby internal organs.

This process is considered irreversible and is fraught with serious consequences, since its development occurs inside a living and still functioning organism. With the timely detection of necrosis, there is a great chance to stop its formation and save the internal organs. However, for this you should know what causes and symptoms precede the development of the disease.

The reasons

Necrosis of the skin of the toes

To prevent the formation of necrosis, each person should be aware that poor blood circulation can provoke the death of tissues and its nearby organs. And the farther away the blood vessels are, the more likely the infection of tissues and organs increases.

• Biological. Infection of internal organs with bacteriological or viral infections.
• Toxicological. Various poisons and toxic substances can cause the death of tissues and internal organs.
• Physical. Injuries, bruises, frostbite or exposure to ultraviolet rays provoke the formation of gangrene.
• Allergic reactions can cause fibroid necrosis.
• Trophoneurotic. With prolonged immobilization, blood microcirculation is disturbed, which is the strongest provocateur of the formation of gangrene.

In addition, endocrine diseases, diabetes mellitus, damage to the spinal cord and large nerve endings contribute to the rapid death of tissues and internal organs.

Symptoms

Ulcers with necrosis of the skin

The main symptom to pay attention to is the complete or partial loss of tissue sensitivity. If necrosis affects only the skin, then at the site of the lesion, a change in their shade can be detected. The skin becomes excessively pale, almost blue, then the color changes, acquiring brownish-black tones. There may be non-healing ulcers.

If the necrosis affects the lower extremities, then the patient may feel cramps and pain, leading to the inability to stand on the leg or causing lameness. With necrotic changes in the internal organs, a violation of the digestive, nervous, genitourinary or respiratory systems may occur. Meanwhile, with necrosis, the body temperature increases, severe weakness, swelling appear, and the heartbeat quickens.

stages

The necrosis of limbs is considered the most terrible disease. However, if diagnosed early, it can be successfully treated. In the process of formation, necrosis goes through several stages:

1. Paranecrosis. The first stage of the disease should not cause much concern. With proper treatment, the patient quickly and without any special consequences for him is on the mend.
2. Necrobiosis. It is considered an irreversible process. At this time, there is a complete metabolic disorder in the tissues, which leads to the prevention of the formation of new cells.
3. Cell death. The cell dies as a result of necrosis.
4. Isolation of enzymes. After its death, the cell begins to secrete harmful enzymes that contribute to the decomposition of tissues. This stage is called autolysis.

Diagnostics

First of all, the medical worker makes a visual examination, listens to the patient's complaints and examines the injury site by palpation. If necrosis affects the lower limbs, its detection is not a problem, since the skin completely changes its shade.

In the event that necrosis affects the internal organs or doctors have some doubts, a number of additional studies are prescribed. These include:

• CT and MRI;
• X-ray examination;
• radioisotope scanning.

Thanks to one of the above methods, it is possible to establish the exact location of the area affected by necrosis, as well as its size and stage of the disease.

Therapy

Severe stage of necrosis

Treatment of the disease is carried out within the walls of a medical institution. We want to note right away that at home, as well as by folk methods alone, necrosis cannot be cured. Necrosis is dangerous because it is fatal, so after making a diagnosis, you must strictly follow the recommendations of specialists.

Medical

Treatment of necrosis will depend on the stage of the disease. First of all, the doctor prescribes medication that will restore blood microcirculation in the affected tissues or organs. Anti-inflammatory drugs are prescribed to relieve the inflammatory process, and antibiotics are prescribed to destroy harmful bacteria.

Folk

No less useful will be ointments prepared with your own hands, which must be applied to the affected area: to prepare the mixture, you will need wax, laundry soap, honey, rosin, vegetable oil and pork fat in equal proportions. All ingredients should be boiled and then cooled. Aloe, garlic, onion grated on a fine grater are added to the resulting mass and mixed. The resulting mixture is applied in the form of a warm compress to the affected area.

The following recipe will require fewer ingredients. In a small bowl should be put in equal proportions:

Everything must be mixed thoroughly. The resulting mixture should be applied at night, on the area of ​​the body affected by necrosis.

Surgical

If drug treatment does not give a positive result, then the patient can be helped only by the surgical method. It should be noted that amputation of a limb or removal of dead tissue is the last resort.

Before proceeding with the operation, doctors perform a number of manipulations:

• Preparation for surgery. Antibacterial therapy and infusion are carried out.
• operational manipulation. Aimed at removing dead tissue or limbs.
• The rehabilitation period, during which it is extremely necessary to consult a psychologist, as well as medication.

Necrosis of the skin or limbs is not a sentence. It should be remembered that if you have been given such a diagnosis, you do not need to withdraw into yourself and panic, but it is better to strictly follow the instructions of specialists.

Operation (video)

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Skin necrosis is an irreversible process of death of living cells. It develops after primary damage as a result of which blood circulation is disturbed. The disease is very dangerous and needs to be monitored by doctors. It is worth noting that the disease can be of different types.

Reasons for the development of necrosis

The condition can start after tissue damage in the following ways:

tissue necrosis

• traumatic;
• toxic;
• trophoneurotic;
• infectious-allergic diseases, as a result of which fibroid necrosis may occur;
• vascular.

Traumatic

A typical case of traumatic necrosis due to frostbite, less often it can be caused by: burns, injury, electric shock or radioactive radiation. It is expressed in a change in skin color to pale yellow, the tissues are dense to the touch, later vascular thrombosis is formed. In case of damage to large areas of the epidermis, a person may have a fever, decrease appetite, and regular vomiting will appear.

Toxic

It is formed due to the influence of toxins on the epidermis. It is more often formed with syphilis, diphtheria, leprosy. Toxic, epidermal necrolysis may appear as a result of exposure to the skin of medicines, alkalis, acids.

Trophoneurotic

It is provoked by a malfunction of the central nervous system. This type includes bedsores, which manifest themselves as a change in the color of the epidermis, numbness, redness and the appearance of a bubble with liquid, then the process fester.

Allergic

This species can threaten people with allergic reactions. Polypeptide protein injections become irritants.

Vascular

It occurs due to a violation of blood circulation in the arteries, due to blockage of blood vessels. Almost all internal organs can be exposed to this type.

Tissue death can begin after bedsores and non-healing ulcers. Violation of blood microcirculation in tissues can cause a heart attack, diabetes mellitus, injuries of the spinal cord and large vessels

Symptoms

Tissue necrosis begins to manifest itself with numbness of the affected area, its color becomes pale and shiny, which highlights the process that has begun against the background of a healthy epidermis. The process that has begun is easiest to stop and restore blood circulation, if this is not done, then the damaged areas turn blue and then turn black.

Other clinical manifestations include:

• convulsions;
• temperature;
• loss of appetite;
• general weakness;
• lameness
• trophic ulcers.

Before necrosis, the affected cells go through several stages:

1. Paranecrosis is a reversible change, a state in which the cell is in agony.
2. Necrobiosis is a period of cell disease that cannot be changed.
3. Apoptosis is the process of death.
4. Autolysis is decomposition.

Regardless of where the pathology is formed, the patient's internal organs are disrupted: kidneys, liver, lungs. This is due to a decrease in the immune system, metabolic disorders that lead to hypovitaminosis and exhaustion.

Types of necrosis

Colliquation necrosis

This type is called wet, the affected tissues are flabby with the presence of pathogenic microorganisms in them. In terms of symptoms, it is similar to wet gangrene, the difference of the latter is that tissue liquefaction occurs a second time due to the addition of pyogenic bacteria. Colliquation necrosis develops very quickly, a person has collateral hyperthermia.

coagulative necrosis

This type is called dry and mainly spreads to protein-filled organs: kidneys, adrenal glands, spleen, myocardium.

The state is also divided into the following types:

Gangrene

The foci are black and dark green in color. Depending on the type of infection, it is dry, wet and gas. It is more often observed on the limbs, before its appearance they become inactive, the skin becomes numb and dries, hair falls out. Basically, preliminary diagnoses are atherosclerosis, endarteritis and others. Then the site begins to hurt as long as there are living cells on it, after which the sensitivity completely disappears.

Joint necrosis

In addition to the skin, pathology can affect the articular tissues, mainly the head, which occurs due to a lack of nutrients supplied to it. Causes can be physical trauma, arterial thrombosis, bad habits, and certain medications. The main symptom is the appearance of a sharp pain, the last stage leads a person to disability. A common example of joint necrosis is aseptic necrosis of the femoral head.

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, intestines, 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

All medical devices are selected exclusively by a doctor, self-treatment is unacceptable. If the drugs are not effective, and aseptic necrosis of the femoral head progresses, surgery is performed.

Treatment of hemorrhagic pancreatic necrosis

Treatment takes place in the hospital, mainly in the intensive care unit.

For pain relief, they use: No-shpa, Ketons, Platifillin, Hydrotartate. The removal of pain is also facilitated by the introduction of injections of Novocain, as well as Pomedol with Atropine Sulfate and Diphenhydramine.
Antibiotics are prescribed: Cefalexin, Kanamycin.

Based on the condition of the patient, doctors decide on the operation. Without infection, the patient is given laparoscopic or percutaneous drainage of the peritoneal area. With a large amount of inflammatory fluid, you need to cleanse the blood. In the presence of an infection, part or all of the pancreas is removed.

Complications and preventive measures

The outcomes of necrosis are positive, in the case of enzymatic fusion of lesions and germination of connective tissue, scarring. Complications are purulent fusion, bleeding, sepsis.

If the treatment of necrosis of the head of the hip joint is later, the consequences threaten with disability. For the purpose of prevention, timely treatment of acute chronic diseases, reduction of trauma, strengthening of the vascular and immune systems are carried out.

Lethal outcome is typical for ischemic strokes, myocardial infarctions and other lesions of internal organs.