What is necrosis? Treatment of soft tissue skin necrosis

Disturbance of innervation

The trophic function of nerves is less important for the normal functioning of tissues than the blood supply, but at the same time, disruption 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 due to injury and disease spinal cord(spinal injury, syringomyelia), damage to peripheral nerves.

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 treatment tactics.

Dry and wet necrosis s

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

Dry (coagulative) necrosis characterized by the 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 occur, and 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 organ's volume, while hyperemia is expressed around the foci of necrotic tissue, there are blisters with clear or hemorrhagic fluid, and the flow of turbid exudate from skin defects. There is no clear boundary between the affected and intact tissues: inflammation and edema spread beyond the necrotic tissues to a considerable distance. The addition of a purulent infection is typical. With wet necrosis, severe intoxication develops (high fever, chills, tachycardia, shortness of breath, headaches, weakness, profuse sweating, changes in blood tests of an inflammatory and toxic nature), which, as the process progresses, can lead to dysfunction of organs 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 tissue and poses a significantly less threat to the patient’s life. In what cases does dry necrosis develop, and in what cases does wet necrosis develop?

Table 13-2. The main differences between dry and wet necrosis

Dry necrosis usually forms when the blood supply to a small, limited area of tissue is disrupted, which does not occur immediately, but gradually. Dry necrosis most often develops in patients with reduced nutrition when there is practically no water-rich fatty tissue. For dry necrosis to occur, it is necessary that there are no pathogenic microorganisms in this area, so that the patient does not have concomitant diseases that significantly worsen immune responses and reparative processes.

In contrast to dry necrosis, the development of wet necrosis is promoted by:

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

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

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

Attachment of infection;

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

Gangrene

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

Characteristic appearance fabrics - 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, gall bladder, mammary gland). For this reason, there is no gangrene of the brain, liver, or pancreas. Foci of necrosis in these organs look completely different in appearance.

Table 13-3. Differences between trophic ulcers and wounds

Damage to an entire organ or most of it. It is possible to develop gangrene of a finger, foot, limb, gall bladder, lung, etc. At the same time, there cannot be gangrene of a limited part of the body, the dorsum of a finger, etc.

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

Trophic ulcer

Trophic ulcer is a superficial defect of integumentary tissues with possible defeat deeper located tissues, with no tendency to heal.

Trophic ulcers usually form due to chronic disorders of blood circulation and innervation. According to etiology, atherosclerotic, venous and neuro are distinguished. trophic ulcers.

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 tissue is usually called a trophic ulcer.

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

Fistulas

Fistula is a pathological passage in tissues connecting an organ, natural or pathological cavity with external environment or organs (cavities) among themselves.

The fistula tract is usually lined with epithelium or granulations.

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

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

General principles of treatment

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

Treatment of dry necrosis

Treatment of dry necrosis is aimed at reducing the area of dead tissue and maximizing the preservation of the organ (limb).

Local treatment

The objectives of local treatment of dry necrosis are primarily to prevent the development of infection and dry out the tissue. To do this, treat the skin around the necrosis with antiseptics and use 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), necrectomy is performed (resection of the phalanx, amputation of a finger,

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

General treatment

For dry necrosis general treatment First of all, it is etiotropic in nature, it is aimed at the underlying disease that caused the development of necrosis. This treatment allows you to limit the area of necrosis minimum volume fabrics. The most effective measures should be taken. If it is possible to restore blood supply by intimothrombectomy or bypass surgery, 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 an immediate threat to the patient’s life. Therefore, when they develop, more radical and vigorous treatment is necessary.

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

Treatment for early stages Local treatment

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

General treatment

In general treatment, the main thing is to carry out powerful antibacterial therapy, including intra-arterial administration of antibiotics. Taking into account 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.

Surgical treatment

Usually, it takes 1-2 days to try to convert wet necrosis to dry, although in each case the issue is decided individually. If, during treatment, swelling decreases, inflammation subsides, intoxication decreases, and the amount of necrotic tissue 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 are progressing, necrosis is spreading, and intoxication is increasing, 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 hospital with wet gangrene limbs, severe inflammation and severe intoxication, there is no need to try to convert wet necrosis into dry necrosis; short-term preoperative preparation (infusion therapy for 2 hours) should be carried out and the patient should be operated on according to emergency indications.

For wet necrosis, surgical treatment consists of removing necrotic tissue within obviously healthy, unchanged tissue. Unlike dry necrosis, given the greater severity inflammatory process, infection, in most cases, high amputation is performed. Thus, in case of wet necrosis of the foot, for example, when hyperemia and edema spread to the upper third of the leg (a fairly common situation), amputation should be performed on the thigh, preferably at the level of the middle third. Such high level 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 necrosis zone, it is very likely that severe postoperative complications from the stump will develop (progression of the infectious process, wound suppuration, development of necrosis), significantly worsening the patient’s general condition and the prognosis for his recovery. In some cases, it is necessary to repeat an even higher amputation.

Treatment of trophic ulcers

Treatment of trophic ulcers, the most common type of necrosis, due to the characteristics of this pathological condition requires additional consideration.

For trophic ulcers, local and general treatment is used.

Local treatment

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

Fighting infection

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

Clearing necrotic tissue

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

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

Closing a defect

After cleansing the ulcer surface and destroying pathogenic microflora, attempts should be made to close the wound defect. With small ulcers, this process goes away on its own; after cleansing the ulcer, the growth of granulations increases, and marginal epithelization appears. In this case, daily dressings should be continued using wet-dry dressings with antiseptics. In cases where the defect becomes small (less than 1 cm in diameter) and superficial, it is possible to switch to treating it with 1% alcohol

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

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

Effective for healing venous (but not atherosclerotic!) trophic ulcers compression therapy. Compression therapy for trophic ulcers refers to the application of a zinc-gelatin bandage to the limb, for which various modifications of Unna paste are used. Rp.: Zinci oxydati

Gelatinae ana 100.0

Aqua destil. 200.0

Method of applying a bandage. The patient is placed 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 leg (including the area of the trophic ulcer). Following this, a layer is applied gauze bandage. Then apply a layer of paste again with a brush, saturating 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 ulcerative surface are epithelialized.

Compression therapy significantly increases the possibility of closing ulcers, but not for a long period. The method does not allow a patient to be cured of trophic disorders, since it does not eliminate the cause of the disease.

General treatment

General treatment for trophic ulcers is primarily aimed at the cause of their development and consists of various methods of improving blood circulation. In this case, both conservative and surgical methods are used. 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 varicose veins).

varicose veins), which normalizes venous outflow from the limb and promotes the final healing of the ulcer.

In addition, antibacterial therapy is used to suppress infection. The method of endolymphatic and lymphotropic administration of antibiotics has proven itself well.

To stimulate the healing process, vitamins, methyluracil, and nandrolone are used.

Gangrene is the death of body tissues that are associated with environment, and the organ acquires a dark, black color. The disease is characterized by a severe course, threatens organ loss and is life-threatening for the patient.

Gangrene was very a common occurrence before the invention of antibiotics and various methods instrumental and laboratory diagnostics, especially during wars. Most limb injuries resulted in their loss. Also, gangrene often developed in a hospital setting, as postoperative complication and the result of the addition of nosocomial infection.

Nowadays, when a huge number of antibiotics are available, this disease is also not uncommon. Thus, according to statistics, more than half of patients with insulin-dependent diabetes mellitus develop gangrene of the lower extremities within 20 years.

Interesting facts!

Causes of gangrene development

There can actually be many reasons for the development of gangrene. But it all comes down to one thing - the lack of blood supply in the affected organ, as a result, oxygen does not reach the tissue, and without oxygen, necrosis, or tissue death, occurs.

Circulatory disorders (“ischemic gangrene”) most often develop in older people:

Diabetes mellitus is the most common reason gangrene, which most often affects lower limbs, namely the feet.
Atherosclerosis – in the obliterating form of the disease atherosclerotic plaque can completely block the lumen of blood vessels, preventing the flow of blood to the organ.
Obliterating endarteritis is an autoimmune vascular lesion that often develops in heavy smokers.
Blockage of blood vessels by a blood clot, and the blood clot can break off after surgery, bleeding, or childbirth.
Thrombophlebitis of the lower extremities.
Raynaud's disease is a syndrome of many diseases in which the innervation of blood vessels is disrupted (systemic lupus erythematosus, scleroderma, severe course cervical osteochondrosis).
Myocardial infarction, ischemic stroke, pulmonary infarction and other diseases.

Impact of physical factors:

Frostbite of the extremities;
burns;
electric shock, including lightning.

Mechanical tissue damage:

Injuries and wounds in which the integrity of blood vessels and nerves is disrupted - gunshot wound, injury from shell fragments, road accidents, and so on;
bedsores of bedridden patients;
state after an “unsuccessful” operation;
prolonged compression of an organ - being under rubble, in a car after an accident, prolonged application of a hemostatic tourniquet or tight plaster bandage, wearing narrow rings, shoes, pulling unusual objects onto the penis, strangulation of a hernia, and so on.

Infectious pathogens of gangrene:

Anaerobic gas gangrene - the causative agent is the anaerobic bacteria clostridium;
Purulent diseases caused by staphylococci and streptococci: lung abscess, purulent appendicitis, peritonitis, etc.;
protea;
meningococcal infection (meningococcemia);
tuberculosis (with caseous pneumonia, pleural empyema);
leprosy or leprosy, and others.

Infections can cause gangrene in the presence of other factors that impair blood circulation (diabetes, wounds, burns, severe intoxication, and so on) or without them. In the presence of diabetes mellitus, even slight paresis and wearing tight shoes can lead to tissue necrosis.

It is not difficult to detect necrosis of myomatous nodes. The most important thing is to seek help from a specialist in time, who will listen to all the patient’s complaints, feel the sore spots, and also prescribe a series of studies that can confirm the diagnosis. Typically, in this case it is used ultrasound scanning pelvic organs.

Necrosis means local death of cells, tissues or organs in the human body. This condition is possible as a result of several factors. In the first case, it may occur due to a trophic disorder. In addition, exposure to any traumatic agent can lead to local death of individual cells or tissues. Various circulatory disorders are another fairly common cause of this state. As for traumatic agents, they can be either thermal, chemical, mechanical, radiation, toxic or electrical. In general, it can be a burn, frostbite or a blow electric shock.

If acids get on the cells, then dry necrosis appears on the face. At chemical burns tissue necrosis makes itself felt. Under the influence of microbial toxins, necrosis of both tissues and cells can develop. If exposed to penetrating radiation, one of the most complex forms of necrosis will develop, which can cause death. All in all, this pathology truly dangerous. It is especially difficult to deal with it in cases where necrosis occurs in the area of organs.

It is also important to note the fact that if toxins or microbes enter the body at such moments, it is quite possible rapid spread necrosis. In such cases, people develop gangrenous
One of the most common forms of this disease It is considered to be chemical necrosis. Quite often it is also called acidic. Arises this disease due to the effect on enamel and dentin of certain acidic products. This can be either food or pharmaceuticals or drink. With regular exposure to acidic foods, over time, teeth lose their enamel layer and, consequently, become softer. If treatment for this pathology is not started in time, then it is quite possible that the process of tooth abrasion will develop.

It should be noted that in some cases, dental necrosis is a consequence professional activities person. This condition is observed, as a rule, in all those people who are forced to work in rooms with excessive accumulation of acid vapors of both organic and inorganic origin. Exposure to chemical components can also trigger the development of this disease.

Children are cute creatures who quite often make us parents quite worried. Special attention moms and dads pay general condition health of your beloved children. This is not surprising, since only healthy baby can be truly happy. Unfortunately, things don't always work out well. Certain illnesses quite often burst into a child’s life, and quite suddenly. Those children who adhere to all the rules of a healthy lifestyle every day are no exception. In this article we will talk about some kidney diseases in children. After reading the information presented, you will be able to find out everything you need about the causes of development, symptoms, diagnosis, as well as methods of treatment for these ailments.

Necrosis is the death of tissue or an entire organ. In the presence of this condition, there is a complete or partial metabolic disorder, which sooner or later becomes the cause of their complete incapacity. Development of this pathological condition occurs in four stages. During the first stage, reversible changes are observed, called in medicine paranecrosis. In the second stage, the face is irreversible dystrophic changes which are also called necrobiosis. The third stage of development of this disease is accompanied by autolysis, that is, the decomposition of the dead substrate. And finally, at the fourth stage of development of this pathology, complete cell death occurs. It is difficult to predict how long all these stages will take, since this disease is very unpredictable.

As for the reasons for the development of this pathology, there are not just many of them, but a lot. First of all, there are numerous mechanical injuries. In addition, burns and frostbite can provoke the development of necrosis. Ionized radiation– another fairly common reason that contributes to the occurrence of this condition. Quite often of this kind damage also occurs as a result of exposure chemical factors such as acid and alkali. Such infectious and non-communicable diseases how diabetes and tuberculosis can also trigger the development of necrosis. It can make itself felt against the background of certain disorders of the nervous or vascular trophism of tissue.

We also draw the attention of all readers to the fact that this type of tissue death in most cases is observed in quite important organs human body. Most often the heart, brain and kidneys are affected. Try to maintain a healthy lifestyle in order to prevent the development of this disease.

In our age of technological and medical progress, people are still forced to deal with necrosis skin. Skin necrosis has another name - gangrene. Necrosis is partial death 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. If necrosis is detected in a timely manner, there is a great chance of stopping its formation and preserving internal organs. However, to do this, you should know what causes and symptoms precede the development of the disease.

To prevent the formation of necrosis, every person should know that poor blood circulation can provoke death of tissue and its nearby organs. And the further away the blood vessels are, the greater the likelihood of infection of tissues and organs.

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

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

Symptoms

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

If necrosis affects the lower extremities, the patient may experience cramps and pain, leading to the inability to stand or causing lameness. With necrotic changes in internal organs, digestive, nervous, genitourinary or respiratory systems. Meanwhile, with necrosis, body temperature increases, severe weakness, swelling, increased heart rate.

Stages

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

Paranecrosis. The first stage of the disease should not cause much concern. At proper treatment, the patient recovers quickly and without any special consequences for him.
Necrobiosis. It is considered an irreversible process. At this time it happens complete violation metabolism in tissues, which leads to the prevention of the formation of new cells.
Cell death. The cell dies as a result of necrosis.
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, medical worker makes a visual examination, listens to the patient’s complaints and examines the site of damage using palpation. If necrosis affects the lower extremities, identifying it is not a problem, since the skin completely changes its color.

If necrosis affects internal organs or doctors have some doubts, a series of additional research. These include:

X-ray examination;
radioisotope scanning.

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

Therapy

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

Medication

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

Folk

No less useful are ointments prepared with my own hands which need to 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. Finely grated aloe, garlic, and onion are added to the resulting mass and mixed. The resulting mixture is applied as warm compress to the affected area.

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

lard;
ash oak bark;
slaked lime.

Everything needs to be mixed thoroughly. The resulting mixture should be applied at night to the area of the body affected by necrosis.

Surgical

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

Before starting the operation, doctors perform a number of manipulations:

Preparation for surgery. Conducted antibacterial therapy and infusion.
Operational manipulations. Aimed at removing dead tissue or limbs.
A rehabilitation period, during which it is extremely necessary to consult a psychologist, as well as drug treatment.

Necrosis of the skin or limbs is not a death sentence. You should remember that if you have been diagnosed with this, you do not need to isolate yourself and panic, but rather strictly follow the instructions of specialists.

Operation (video)

Even in modern world Anyone can face a problem such as tissue necrosis. In this article, this disease will be discussed.

What is it

First of all, you need to understand the concepts themselves that 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. One can even say that this is the end result of the breakdown of tissues of a still living and functioning organism. Important: necrosis is also called gangrene (this is one of the subtypes of the disease). This disease develops exclusively in those tissues that have the prerequisites for death, i.e. in previously damaged ones.

Reasons

It is also necessary to talk about why tissue necrosis can occur in a living organism. What are the prerequisites for the emergence of this terrible disease? So, generally speaking, gangrene begins to develop in those organs or tissues where blood circulation is impaired. And the further the body part is from the main blood vessels, the more likely he is to become infected.

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

Tissue necrosis may occur due to certain diseases. So, diabetes mellitus may be the cause of this disease. Damage to the spinal cord or large nerves can also contribute to the occurrence of necrosis.

About the types of disease

I would definitely like to say that tissue necrosis can be classified. What could this disease be, depending on the mechanism of action?

Direct necrosis. It occurs as a result of injuries, poisoning by toxins, or due to the work of certain microorganisms.
Indirect necrosis. It occurs indirectly, through body systems such as the cardiovascular or neuroendocrine. These can be allergic, trophoneurotic and vascular necrosis.

IN medical practice There are two more types of this disease:

Liquation necrosis. Along with tissue necrosis, swelling occurs.
Coagulative necrosis. With this subtype of the disease, along with tissue necrosis, complete dehydration occurs.

Symptoms

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

Lack of sensitivity, numbness of the tissue.
Paleness of the skin (this may be so-called “waxy” skin).
If you do not deal with the previous symptom, the skin first begins to turn blue, then turn green or black.
If the disease affects the lower limbs, it becomes difficult for the patient to walk. Feet may also feel cold even when high temperatures air.
Lameness in the legs and muscle twitching may occur.
Also, ulcers often begin to appear that do not heal. It is with this symptom that gangrene begins.

Stages of the disease

A very terrible disease in its nature and end result is tissue necrosis (photos of patients with such a disease are the first confirmation). However, it is worth saying that this disease occurs in several stages.

Paranecrosis. These changes are still reversible; if treated in time, you can get rid of the disease without any consequences. negative consequences for the body.
Necrobiosis. These changes are already irreversible. In this case, it is violated important exchange substances in tissues that prevent the formation of new healthy cells.
Cell death.
Autolysis. This is already a process of complete tissue decomposition. It occurs under the action of enzymes that release dead cells.

Coagulative necrosis

It most often affects those parts human body, which are rich in proteins, but also poor in various body fluids. For example, this may be coagulative necrosis of liver cells (adrenal glands or spleen), where lack of oxygen and poor blood circulation most often occur.

Subtypes of coagulative necrosis

There are several subtypes of so-called “dry” necrosis:

Heart attack. This is vascular tissue necrosis. By the way, the most common disease.
Curdled or caseous necrosis. Occurs if a person has diseases such as leprosy, syphilis, tuberculosis. With this disease, a piece of dead tissue is found on internal organs, it may crumble. If the patient is syphilitic, areas of dead tissue will appear as a whitish liquid (similar to cottage cheese).
Zenker's, or waxy, necrosis. This subtype of the disease affects muscle tissue.
Fibrinoid necrosis. This is the dying off of areas connective tissue. The causes of its occurrence are most often autoimmune or allergic diseases.
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 is also found in the mammary glands).
Gangrene.

A few words about gangrene

I would definitely like to say a few words about such a disease as gangrene. This is one of the subtypes of tissue necrosis. It affects areas of the body that are actively in contact with the external environment. Why was this disease identified in separate group? It’s simple; often when the skin is affected by gangrene, it also becomes infected with bacteria. And along with this, the disease undergoes secondary changes. Scientists distinguish the following types of gangrene:

Dry. In this case, tissue necrosis occurs without the participation of pathogens. Occurs most often on the patient’s extremities. This may be atherosclerotic gangrene (occurs as a result of a disease such as vascular atherosclerosis); gangrene, which occurred due to exposure to temperatures (burn or frostbite of the skin); gangrene that affects the fingers ( vibration disease or Raynaud's disease), or gangrene, which affects the skin when infectious rashes(for example, during typhus).
Wet gangrene. It occurs as a result of the attachment of a bacterial infection to dead tissue. It develops most often in internal organs. Infection often results in bad smell. With this type of gangrene, gangrene is possible deaths.
Gas gangrene. Occurs after infection of the wound with anaerobic flora. As a result of the disease, a large area of tissue becomes infected and gas is formed. The main symptom: crackling under the fingers during palpation. It is worth saying that the percentage of deaths is also quite high.
Bedsores. This is the necrosis of individual areas of tissue under pressure. They occur most often in bedridden patients. In this case, the nerves and blood vessels are compressed, blood circulation is disrupted, and this disease occurs.

Aseptic necrosis

Aseptic necrosis develops due to disruption of the blood flow of the vessels that supply the head of the femur (this is the so-called “hinge” 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 old. Important point: aseptic necrosis is very similar to arthrosis hip joint according to its symptoms. Therefore, these diseases are very 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.
Appearance of lameness.
Restricted mobility of the affected leg.
Atrophy of the thigh muscles.
There may be either shortening or lengthening of the leg affected by necrosis.

As for treatment, its success depends entirely on the extent of the disease. How can necrosis be diagnosed? bone tissue in the early stages of the disease:

Computed tomography - CT.
Magnetic resonance imaging - MRI.

It is impossible to detect bone necrosis at an early stage using x-rays. On X-ray examination you can already see the signs aseptic necrosis. It is also impossible to identify this disease using tests. As for 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 decidual tissue itself plays important role at the moment of implantation of the fertilized egg. She rules out various damages the walls of the uterus. And if it begins to die, this is a signal that the unborn child needs the care of qualified specialists. As a result of infection of this tissue, blood circulation will be impaired, which can cause not only the breakdown of decidual tissue, but also fetal rejection.

Consequences of necrosis

Regardless of the cause of this disease in the 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). So, what could be the consequences of necrosis:

Scarring or replacement. In this case, the necrotic masses are replaced by connective tissue.
Removal of dead cells. This occurs thanks to phagocytes and lysosomal enzymes of leukocytes.
Encapsulation. In this case, the focus of necrosis is limited to the connective tissue.
Cell calcification. In this case, areas of dead tissue are saturated with calcium salts.
Ossification. Here, bone tissue begins to form in the dead areas.
Cyst formation.
Melting of tissue with pus. Sepsis is often the consequence. 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 earlier necrosis is detected, the easier it will be for the patient to cope with the problem. The danger of the disease is that it can be fatal. That is why, when the very first symptoms or even doubts about tissue death appear, you should seek medical help. Self-medicating in this case can be a life-threatening activity.

Bedsores

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

Ensure that the patient's bed is clean, level, and moderately hard. There should be no folds on the sheet.
The patient should be turned as often as possible.
It is also important to rub bedsores and massage the lesions as often as possible. Do everything to improve blood circulation in these affected areas.
Bedsores should also be lubricated with salicylic or camphor alcohol.
Inflatable rings specially designed for such cases should be placed under the patient’s lower back or sacrum.

Dry necrosis

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

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

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

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

A small conclusion: if the patient has necrosis, 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 due to necrosis. And, of course, the patient will be prescribed antibacterial therapy. This is necessary in order to avoid contamination of dead tissue with a bacterial infection (after all, this is what can lead to death).

Wet necrosis

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

Local treatment for wet necrosis

What will doctors do in this case:

It is necessary to regularly wash the wound with a solution of hydrogen peroxide (3%).
The so-called pockets and leaks will be opened, it is necessary various ways drainage.
It is also important to apply antiseptic dressings. To do this, you can use drugs such as Furacilin, Chlorhexedine, Boric acid.
Therapeutic immobilization (application of plaster splints) will also be mandatory.

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.

Antibacterial therapy. In this case, the patient will be given antibiotics intravenously or intra-arterially.
Vascular therapy. Doctors will try to restore blood circulation in the tissues affected by necrosis.
Detoxification therapy. The efforts of specialists will be aimed at preventing infection of living tissues that are located near the site of necrosis.

Surgical intervention

If a patient, for example, has wet necrosis of soft tissues, treatment may no longer help him. In this case you will need surgery. Those. Surgeons should begin working with the patient. As mentioned above, at the very beginning of treatment, specialists will try to convert wet necrosis into dry, this can take no more than a couple of days. If positive results is not observed, the patient will have to be sent for surgery. By the way, in this case it is the only way save the patient's life.

Preoperative preparation. Here you will need antibacterial and infusion therapy.
Operation. Removal of necrosis within still intact and viable tissue. However, doctors know that pathogenic bacteria may already be present in healthy tissues. Therefore, the so-called “high” amputation is most often welcomed, when part of the healthy tissue is excised along with the affected area.
Postoperative period. If necrosis of the patient’s skin ends with surgery and removal of part of the limbs, in this case, not only medical support for the patient will be required for some time after the operation, but also psychological support.

Folk remedies

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

If a patient has a problem such as bedsores, they can be dealt with in the following ways. So, you need to lubricate the affected areas sea buckthorn oil. You can make lotions from rosehip oil (all this is sold at the pharmacy).
Ointment for bedsores. To prepare it, you need to take crushed oak bark (two parts), black poplar buds (1 part) and butter(6-7 parts). The ingredients are mixed, left overnight in a warm place, after which everything is boiled and filtered. After this, the ointment is ready for use.
Ointment for necrosis. To prepare it, you need a tablespoon lard mix 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, and left overnight. In the morning everything needs to be removed. You need to do this three evenings in a row.
Treatment of skin necrosis of soft tissues can be carried out using herbal decoction. To prepare it, you need to pour two kilograms of ordinary chestnut fruit with water so that the ingredients are completely covered. Everything is boiled for about 15 minutes. After this, the water is poured into a jar, and the chestnuts are filled with fresh water. The procedure is repeated again. After this, 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 broth, add 5 liters cold water and make baths. The procedures must be repeated daily until the problem disappears.