Treatment of soft tissue necrosis. Types of necrosis, forms of pathology

Skin necrosis is a pathological process that is contained in the death of a piece of tissue. It begins with swelling, after which denaturation and coagulation occur, which leads to the last stage - this is the destruction of cells.

What causes skin necrosis?

There are a couple of reasons for the development of skin necrosis:

circulatory disorders;
exposure to pathogenic bacteria and viruses;
traumatic necrosis;
toxigenic necrosis;
trophoneurotic necrosis;
ischemic necrosis;
physical injury;
chemical injury.

But it is possible not to bring skin necrosis to the last stage of tissue death, if the manifestations of the disease are noticed in a timely manner.

Symptoms of skin necrosis

Among the first signs of manifestation of skin necrosis, numbness of the anatomical site and lack of sensitivity are noted. At the end of which, the pallor of the affected area of the skin appears, which is replaced by a blue color and, as a result, blackening with a green tint. In addition, there is a general deterioration in the patient's condition, which manifests itself:

high temperature;
increased heart rate;
puffiness;
hyperemia.

An indicator that makes past symptoms more convincing is pain under the affected skin area.

Skin necrosis after surgery

Skin necrosis is one of the negative consequences of poor-quality preparation for surgery. The disastrous outcome of surgical intervention in most cases manifests itself two to three days after the end of the operation. Superficial skin necrosis is located along the suture. The deepest necrosis of the suture contributes to its divergence, which significantly worsens the patient's condition and complicates the course of the disease itself.

Among the circumstances of the formation of skin necrosis at the end of operations, the following are noted:

insufficient amount of blood supply;
large tissue detachment;
excessive tension of the seams;
infection of damaged areas of the skin.

Treatment of skin necrosis with folk remedies

To cure the disease at home, you need to prepare ointments. Among the many existing recipes, we noted two.

To make the first tool you need:

Take 50 grams of wax, honey, rosin, lard, laundry soap and sunflower oil.
Put all the ingredients in a saucepan, stir vigorously and boil.
Then, allow the mass to cool and add in that direction 50 grams of finely chopped onion, garlic and aloe.
Mix everything vigorously.

Before applying the ointment to the affected area, you need to warm it up.

The second recipe for a folk remedy for the treatment of skin necrosis is easier to apply:

Take one tablespoon of bacon, one teaspoon of slaked lime and oak bark ash.
Mix all ingredients well.

The ointment is applied with a bandage at night, and removed in the morning. The course lasts three days.

Treatment of skin necrosis depends on the form of the disease and the stage of its development. Local treatment includes two stages:

prevention of infection;
excision of dead tissue.

The second stage occurs only after two to three weeks of effective treatment. With non-specialized treatment, therapies are prescribed:

bactericidal;
detoxification;
vascular.

In addition, surgical intervention is possible, but it is used very rarely.

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 newly formed cells take their place, 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 more or less pronounced 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 located 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 through” 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-

More characteristic is the development of small superficial necrosis (trophic ulcers), while in violation of the arterial blood supply, extensive necrosis and gangrene of the extremities often occur (trophic ulcers may also appear). 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 a long 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 organ dysfunction 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 in 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 a burn 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 one, 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 worsens 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-

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

Causes of necrosis

Most often lead to the development of necrosis:

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

Classification

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

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

Classification by clinical manifestations:

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

Symptoms of the disease

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

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

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

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

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

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

There are several types of gangrene:

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

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

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

Outcome of the disease

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

Diagnostics

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

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

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

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

Treatment of necrosis

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

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

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

Any processes that ensure the viability of the body occur at the cellular level. When exposed to negative external or internal factors, these mechanisms are disrupted and tissue necrosis or necrosis occurs. This is an irreversible process that can provoke extremely dangerous, and even fatal consequences.

Tissue necrosis - causes

Successful therapy and stopping the process of cell death is carried out only after establishing the origin of the pathology. Additionally, the form of the disease is clarified. Depending on the morphology and clinical signs, the following types of necrosis are distinguished:

cheesy;
coagulation (dry necrosis);
sequester;
colliquational (wet necrosis);
bedsores.

According to the etiology, tissue necrosis is classified into the following types:

traumatic;
toxigenic;
trophoneurotic;
allergic;
ischemic.

Traumatic necrosis

The described variant of the problem develops against the background of severe mechanical damage. This type of disease is a direct tissue necrosis - what it is: cell death after direct exposure to external physical or chemical factors. These include:

electric shock;
burns, including chemical agents;
penetrating deep wounds, open wounds and injuries (fractures, bruises);
ionizing radiation.

Toxic necrosis

The presented form of the disease occurs due to poisons of biological origin. It is often an infection that causes soft tissue necrosis, such as:

diphtheria bacillus;
chickenpox virus;
toxoplasma;
streptococci;
clostridia;
and others.

Poisoning and destruction of cells begins due to the influence of the waste products of pathogenic microorganisms and viruses on them. Toxic epidermal necrolysis can also develop against the background of contact with chemical compounds:

mercury chloride;
alkalis;
ethyl alcohol;
acids;
some medicines;
salts of heavy metals.

Trophoneurotic necrosis

For the normal functioning of the organic system, its correct innervation and good blood supply are necessary. These facts determine trophoneurotic tissue necrosis - what it is: cell necrosis due to damage to the central or peripheral nervous system, arteries, veins or capillaries. In most cases, this pathology occurs against the background of immobilization. A good example is the death of skin tissue during the formation of bedsores. Sometimes the disease develops as a secondary phenomenon or symptom of severe ailments of the nervous system.

This type of irreversible cell death is extremely rare. The only thing that can cause tissue necrosis of allergic origin is the occurrence of pathological immune complexes. They are formed in response to the use of certain medications and contact with specific irritants. Such complexes are deposited on the inner surface of the capillaries and cause an acute inflammatory process that provokes the death of living cells.

Vascular necrosis

Ischemic death or infarction is considered one of the most common types of indirect damage to organic structures. This condition is extremely dangerous, especially if vascular tissue necrosis progresses in the region of the heart and respiratory tract, which is easier to understand by thoroughly studying the sequence of pathological processes.

Violation of blood flow in the veins or arteries leads to hypoxia. Against the background of oxygen starvation, metabolism worsens, and cell death begins. If the blood flow is completely stopped, necrosis occurs immediately, the development mechanism in this case is rapid. This provokes such changes in the vessels as embolism, thrombosis, prolonged spasms.

Tissue necrosis - symptoms

The clinical picture depends on the localization of cell damage (skin, bones, internal organs). The signs that accompany the pathological process, and the likelihood of a cure, also depend on the stage of necrosis. At the first stage, the process is still reversible, from the second period it will not be possible to restore tissues. There are such stages of the disease:

cell death or paranecrosis;

necrobiosis;

dying off;

autolysis or decomposition.

Skin tissue necrosis

Dermal lesions are easy to notice even on their own, especially in the later stages of progression. Soft tissue necrosis begins with numbness of the damaged areas, a tingling sensation. Other specific symptoms:

puffiness;
redness of the skin;
loss of sensitivity;
freezing of the extremities;
convulsions;
general weakness;
persistently elevated body temperature.

Dying areas are first pale, shiny. Gradually, they become blue-violet and slowly blacken, trophic ulcers form. It clearly shows what such tissue necrosis looks like, the photo below. The necrosis is accompanied by the processes of decay and slow decomposition. Because of this, the most unpleasant thing that accompanies tissue necrosis is felt - the smell. It is sweetish-sour, fetid and difficult to bear, practically uninterrupted by anything.

Bone necrosis

Nutrition is also required for solid organic formations, so a violation of metabolic processes can provoke changes in their structure. With a deterioration in blood supply under the skin and muscles, necrosis of bone tissue sometimes begins, what it is, the patient does not immediately understand, in the early stages there are no obvious symptoms of the problem. Inflammation is also absent, and destruction occurs slowly. First, the bone loses its density and becomes brittle, sometimes hollow, after which tissue necrosis occurs. This is accompanied by a more pronounced, but non-specific clinic:

pain;
restriction of mobility;
swelling near the joints.

Necrosis of internal organs

It is difficult to recognize the described type of cell death in the early stages of progression. Signs of tissue necrosis in this case depend on what is affected. The necrosis of internal organs is manifested by various symptoms that can resemble many diseases:

deterioration in general condition;
permanently elevated body temperature;
increased heart rate;
arterial hypertension;
violations of the breathing process;
digestive and stool disorders;
loss of appetite;
shortness of breath and other signs.

Why is tissue necrosis dangerous?

A favorable prognosis is made only for simple cases of cell death. Foci of damage are replaced by connective (scars) or bone tissue, or a dense protective capsule is formed around them. The maximum danger is purulent tissue necrosis, the infection causes rapid melting of organic structures, bleeding and generalized sepsis. In the latter case, death is likely.

The necrosis of vital internal organs is similarly difficult. Necrosis progresses rapidly, provoking their failure. Without an emergency transplant, the chances of survival decrease very quickly. The most dangerous are damage to the membranes and tissues of the following organs:

spleen;
liver;
brain;
heart;
kidneys (cortex).

Tissue necrosis - what to do?

If you find any signs of cell death, you should immediately consult a doctor. Otherwise, irreversible complications will cause tissue necrosis, treatment should be carried out only by a specialist and in a hospital setting. In the early stages of the pathological process, drug therapy is successfully used, which provides relief of inflammatory processes and stopping the necrosis of organic structures, encapsulation of damaged areas and scar formation.

If necrosis is diagnosed at the later stages of development, which is fraught with loss of working capacity and even death, more radical measures are prescribed. All dead areas must be removed surgically, partially capturing the surrounding healthy tissue. This may involve segmental or complete amputation of fingers or limbs, removal and transplantation of internal organs. With generalized blood poisoning (sepsis) and damage to the brain, heart, liver, it is often not possible to save the patient.

Necrosis is a dangerous disease characterized by the irreversible cessation of the vital activity of cells, tissues and organs due to exposure to pathogens. In this case, the death of body tissues that have a connection with the environment is noted, the affected tissue or organ becomes black. The disease is life-threatening for the patient.

Before the invention of antibacterial drugs, various methods of instrumental and laboratory diagnostics, especially during wars, this pathology was a frequent occurrence. Most of the wounds of the legs and arms ended in their loss. Quite often, the disease developed in the hospital as a result of postoperative complication as a result of the accession of a nosocomial infection.

Nowadays, this pathology is also not rare. However, today there are many methods of therapy. Treatment of tissue necrosis with folk remedies is also possible, but only if the problem is detected on time, as an aid.

There are plenty of reasons for tissue necrosis. However, they all come down to a common one - the lack of blood supply in the affected organ. As a result, oxygen does not enter the tissues, necrosis develops.

The occurrence of gangrene may be due to:

the presence of diabetes mellitus, thrombophlebitis, obliterating endarteritis, atherosclerosis;
frostbite of the limbs;
radiation sickness;
electric shock;
injuries, wounds, characterized by a violation of the integrity of blood vessels and nerves;
prolonged squeezing of the organ;
tuberculosis;
acid, alkaline burns;
exposure to the body of harmful substances: mercury, acetone, lead;
metabolic disorders;
pathogenic microorganisms.

The first dangerous sign of necrosis is tissue numbness, loss of sensitivity. In addition, the necrosis of tissues or organs is characterized by impaired blood circulation. If you do not take action at the initial stage of the pathology, do not start treating it, the disease will progress - the skin will begin to turn blue, blacken, turn green.

Damage by necrosis of the lower extremities is characterized by fatigue, chills, convulsions, soreness, lameness, and the appearance of non-healing trophic ulcers. With gangrene, there is a deterioration in general well-being, circulatory disorders, the appearance of malfunctions in the functioning of the central nervous system, kidneys, respiratory system, and liver. Further, there is a significant decrease in the protective properties of the body, as well as the development of concomitant pathologies, including anemia, hypovitaminosis, and nervous exhaustion.

There are several types of gangrene: necrosis of the joints, skin, bones, internal organs, retina, etc.

The use of folk remedies for the treatment of necrosis of soft tissues, bones or joints should be appropriate and without fail approved by the attending physician. It is also not necessary to refuse medical treatment in favor of folk. Only complex therapy contributes to the cure of pathology and the normalization of general well-being and condition.

Effective recipes for the treatment of necrosis of the musculoskeletal system

If the problem is identified in the early stages, then along with conservative therapy, traditional medicine can be used. Any delay and refusal of treatment is fraught with disastrous consequences.

Treatment of necrosis with folk remedies involves the use of decoctions, infusions, ointments, compresses, and other drugs. All medicines consist entirely of natural ingredients. In order to achieve the maximum therapeutic effect, try to observe the proportions, dosages, as well as the frequency of use of the formulations. It is also not recommended to abuse the funds.

The main cause of aseptic necrosis of the hip joint is the cessation of the blood supply to the joint.

Necrosis of the head of the hip joint is usually caused by: joint injuries, the presence of addictions, embolism, venous stasis, violation of the integrity of blood vessels, pancreatitis, as well as exposure to ionizing radiation on the body. The necrosis of the hip joint can be cured not only with the help of conservative and surgical methods, but also with alternative medicine.

Pine buds for the treatment of pathology. To prepare the product, you need to take sugar and fresh pine buds. The ingredients should be laid out in layers to about half the bottle. Next, the container is closed with a lid and placed in heat for a week. When the syrup forms in the jar, rub it into the affected joint. The same medicine is intended for oral administration. Take three tablespoons of the drug twice a day. The duration of the therapeutic course is two months.
Sabelnik will help in the treatment of necrosis of the femoral joint. This plant helps to eliminate pain and activate blood supply. Pour the crushed dried plant in the amount of fifty grams of vodka - a liter. Place the hermetically sealed container in a dark, cool place for a month. After this time, filter the preparation. Take thirty drops of the drug every day. In order to achieve a greater therapeutic effect, rub the tincture into the affected joint.
The use of healing compresses. Cabbage is the best assistant in the fight against ailments of the musculoskeletal system. Take a couple of cabbage leaves, beat them a little until the juice is released, and then brush with honey. Apply the sheet with the greased side to the painful area. Put polyethylene on top of the sheet and insulate.
Healing baths in the fight against necrosis of the joints. Turpentine baths contribute to the cure of the disease. To improve the therapeutic effect, in addition to half a teaspoon of turpentine, add crushed Jerusalem artichoke rhizomes, pine branches, and sea salt to the bath. Salt must first be dissolved. The duration of the procedure is ten minutes. After water procedures, apply iodine mesh and honey to the affected area. The therapeutic course consists of twenty such procedures.

Therapy of foci of skin necrosis

Necrosis of the skin is a pathological process consisting in the death of part of the tissue. The disease is characterized by edema, hyperemia, increased heart rate, fever and malaise. A good effect can be achieved using medicines in combination with remedies from plants and other natural ingredients.

1. Application of healing ointment. Mix equal proportions of wax with honey, lard, rosin, sunflower oil and laundry soap. The composition must be brought to a boil. After the mass has cooled, add chopped garlic, onion and aloe. Mix well. Apply the product to the affected area twice a day. Before applying the ointment, it must be heated.

2. Mix 30 grams of melted pork fat with slaked lime - a teaspoon and the same amount of oak bark ash. Mix ingredients thoroughly. You need to use the ointment before going to bed, at night, under a bandage. The duration of the therapeutic course is five days.

3. The use of baths. Pour the chestnut fruits in the amount of two kilograms with water (so that it covers the raw materials). Place the container on the stove, wait for it to boil. Reduce the heat, boil the composition for about 15 minutes. Next, pour the liquid into the bottle, and again fill the chestnuts with water and boil. Combine both decoctions and boil until two liters of liquid remain. Pour the decoction into the bath. The duration of water procedures is a quarter of an hour. Carry out the procedure every other day.

Necrosis of the pancreas

It is characterized by changes and death of organ tissues. Along with drug therapy, proper nutrition, the disease can be cured by means of alternative medicine.

Application of infusion of Japanese Sophora. Brew 20 grams of chopped herbs in 20 ml of boiled water. Remove the container in a warm place for two hours. Drink a quarter cup of the filtered drink three times a day, before meals. The duration of the therapeutic course is one and a half weeks. A second course can be carried out after two weeks, not earlier.
Blueberry infusion in the fight against pancreatic necrosis. Soak 30 grams of crushed leaves and berries of the plant in two hundred milliliters of boiling water. Leave the composition to infuse. Drink 50 ml of strained drink three times a day.

Gangrene of the lower extremities

There are dry necrosis and wet. Dry gangrene occurs due to a sharp blockage of oxygen access to tissues. It is characterized by tissue shrinkage, gradual wrinkling and reduction in size. If measures are not taken in time, dry gangrene will turn into wet due to infection. This type of necrosis is more dangerous, as it is fraught with blood poisoning, complete intoxication of the body. In the early stages of marking the limbs, such remedies will help.

1. The use of compresses with curdled milk. Soak gauze folded in several layers in yogurt and apply to the affected area. Change compresses as often as possible.

2. Rye bread in the fight against gangrene. Take a piece of rye bread, chew it and salt it well. Put the mass on the affected area and bandage. For the best effect, you can put a couple of cabbage leaves on the bread. Perform the procedure three times a day.

3. Clove oil will help in therapy. Soak a gauze pad in oil and apply it to the affected area. Secure with a bandage. The procedure must be carried out three times a day.

Breast problems

Fatty necrosis of the mammary gland is characterized by focal aseptic necrosis of fatty tissue with its subsequent replacement with scar tissue. Treatment of fatty necrosis of the mammary gland is surgical. Traditional medicine can be taken as an adjuvant therapy in the recovery period.

Mix in equal proportions the crushed dried pomegranate bark with the bark of viburnum branches, and the bark of oak branches. Brew 30 grams of raw materials with boiling water - 300 ml. Bring the composition to a boil. Reduce heat and simmer for another five minutes. Consume 50 ml of the filtered medicine three times a day, before meals.
Combine viburnum juice with honey in equal proportions. Mix the ingredients thoroughly and use a teaspoon of the drug twice a day - in the morning and in the evening.

Treatment of necrosis with folk remedies is effective and efficient. However, the use of herbal remedies is necessary as an additional treatment. Before applying this or that composition, do not forget to consult your doctor about its appropriateness.