Tissue necrosis after amputation. Necrosis and its types, symptoms, causes, diagnosis and treatment. Changes in the intercellular substance during necrosis

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

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

In its development, this disease goes through 3 stages:

Pre-necrosis.

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

Death of tissues.

Necrosis of the affected cells occurs.

Destructive changes.

Pathological tissues disintegrate.

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

With necrosis internal organs The diagnostic procedure is more extensive and may include:

Ren tgenography.

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

Radioisotope scanning.

It is prescribed in cases where the previous diagnostic method was unsuccessful. To carry out this procedure, the patient is given medical drug, which contains a radioactive substance. A few hours later, zones of radioactivity are detected in the patient’s body. The area affected by necrosis, due to the lack of blood circulation in it, will be presented in the image as a “cold” spot.

Computed tomography.

Used at all stages, if bone necrosis is suspected. At an early stage of the development of this pathology, the diagnostician, when performing a CT scan, should pay attention to the presence of cystic cavities filled with fluid. The presence of such formations, when previous research methods are unfruitful; The patient's complaints will help determine the diagnosis.

Magnetic resonance imaging.

Effective at any stage of the disease, painless, safe for the patient. Through this method Research can detect even minor errors that are associated with impaired blood circulation in the tissues of internal organs.

Treatment methods for necrosis

How is surgery performed for necrosis?

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

Necrotomy.

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

Indicated for wet necrosis, within the framework of non-dead tissue. The signal for carrying out this manipulation is the appearance of a clear boundary, which separates healthy tissue from pathological tissue.

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

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

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

When amputating a limb, resection is carried out significantly above the visible level of the lesion. The length of hospital stay after amputation is completed can vary from 6 to 14 days. IN postoperative period the patient must take a course of antibiotics and painkillers. If there are no complications after the manipulation, prosthetics can be performed after 2 weeks.

Amputation due to necrosis is fraught with the following complications:

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

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

Endoprosthetics

Provides for replacing the affected joint with an artificial one. The implant must be made from durable materials(titanium, zirconium). The pin is fixed using cement/glue. Endoprosthesis replacement is a common operation for bone lesions among patients over 50 years of age. The procedure in question is quite complicated to perform. Among the postoperative complications, the most popular are: infection, loosely fixed prosthesis (needs re-operation).

Arthrodesis

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

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The cause of death of skin tissue can be physical or chemical injuries, allergic reactions, innervation disorders. Post-infectious necrosis of the skin and subcutaneous tissue, bedsores are very serious, extremely unpleasant conditions. Bedsores appear as a result of constant pressure, poor circulation and influence nervous system on nutrition and metabolism in the body, dry skin, insufficient care for a bedridden patient, anemia, etc.

The appearance of necrosis after injections is explained by the administration of very large doses of medication, after which reflex arteriolospasm develops, and then tissue hypoxia. To prevent the development of post-injection skin necrosis, a novocaine solution should be administered simultaneously with the drug and cold applied to the injection area.

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Skin necrosis after surgery

Careful preparation before surgery, application modern methods provide a significant reduction in the number of cases of skin necrosis, but still, no matter how careful compliance with sterility standards is, the risk group for complications after surgery includes patients suffering from diabetes, hypertension, and smokers. The first signs of necrosis are observed 2-3 days after surgery.

Treatment of skin necrosis

Skin necrosis

Skin necrosis is a pathological process that involves the death of part of the tissue. It begins with swelling, after which denaturation and coagulation occurs, which leads to the last stage - cell destruction.

Why does skin necrosis develop?

There may be several reasons for the development of skin necrosis:

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

But skin necrosis can not be brought to the last stage of tissue death if manifestations of the disease are noticed in time.

Among the first symptoms of skin necrosis are numbness of the anatomical area and lack of sensitivity. After this, the affected area of the skin appears pale, which gives way to a blue color and, ultimately, blackening with a green tint. There is also a general deterioration in the patient’s condition, which manifests itself:

A sign that makes the previous symptoms more convincing is pain under the affected area of the skin.

Skin necrosis after surgery

Skin necrosis is one of the negative consequences of poor preparation for surgery. The harmful results of surgery usually appear two to three days after the operation. Superficial skin necrosis is located along the suture. Deep necrosis of the suture promotes its divergence, which significantly worsens the patient’s condition and complicates the course of the disease itself.

Among the reasons for the formation of skin necrosis after operations are:

insufficient blood supply;
significant tissue detachment;
excessive seam tension;
infection of damaged skin areas.

Treatment of skin necrosis with folk remedies

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

To prepare the first remedy you need:

Take 50 grams of wax, honey, rosin, lard, laundry soap and sunflower oil.
Place all ingredients in a saucepan, mix thoroughly and boil.
After this, let the mixture cool and add 50 grams of finely chopped onion, garlic and aloe.
Mix everything thoroughly.

Before applying the ointment to the affected area, it is necessary 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 lard, one teaspoon of slaked lime and oak bark ash.
Mix all ingredients thoroughly.

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:

preventing the development of infection;
excision of dead tissue.

The second stage occurs only after two to three weeks of effective treatment. For general treatment, the following therapies are prescribed:

Surgery can also be performed, but it is used extremely rarely.

Magazine headings

The disease in question is a pathological process during which living cells in the body cease to exist and their absolute death occurs. There are 4 stages of necrosis, each of which is represented by certain symptoms and is fraught with a number of consequences.

Causes and symptoms of necrosis

The disease in question can occur under the influence of external (high/low temperatures, toxins, mechanical stress), internal (hypersensitivity of the body, metabolic defects) factors.

Some types of necrosis (allergic) are quite rare, others (vascular) are very common among the population.

A common point for all types of this pathology is its danger to human health and life if treatment is ignored.

Traumatic necrosis

This type of necrosis can occur due to several factors:

This includes injury due to impact or fall. Traumatic necrosis can develop due to electrical trauma. The effect of temperatures (high/low) on a person’s skin can cause burns/frostbite in the future.

The affected area of the skin changes in color (pale yellow), elasticity (thickened), and becomes insensitive to mechanical influences. After a certain time, escudate and vascular thrombosis appear in the wound area.

With extensive damage, the patient's temperature rises sharply, body weight decreases sharply (due to vomiting, loss of appetite).

The death of body cells occurs against the background of radioactive radiation.

Toxic necrosis

This type of necrosis can develop under the influence of toxins of various origins:

Often, necrosis of this kind is diagnosed in patients with leprosy, syphilis, and diphtheria.

This includes alkalis, medications, and acids.

Depending on the location of the lesion, the symptoms of toxic necrosis will vary. General manifestations of this type of necrosis include: general weakness, fever, cough, weight loss.

Trophoneurotic necrosis

This pathology occurs as a consequence of malfunctions in the central nervous system, which affects the quality of the supply of nerves to the body’s tissues.

Inadequate “cooperation” of the central nervous system and the peripheral nervous system with the body provokes dystrophic changes in tissues and organs, which leads to necrosis.

An example of this type of necrosis is bedsores. Frequent causes of bedsores are regular/excessive pressure on the skin with tight bandages, corsets, or plaster.

At the first stage of the formation of trophoneurotic necrosis, the skin color changes to pale yellow, pain There is not.
After a certain period, small blisters filled with liquid appear on the affected area. The skin under the blisters becomes bright red. If left untreated, suppuration of the skin surface subsequently occurs.

Allergic necrosis

This kind of illness affects patients whose bodies are hypersensitive to microparticles, which provoke an allergic reaction.

An example of such irritants are protein and polypeptide injections. Patients complain of swelling of the skin in the places where the injection was made, itching, and pain.

If the described symptoms are ignored, the pain increases and body temperature rises. This type of necrosis often develops against the background of infectious-allergic and autoimmune diseases.

Vascular necrosis - infarction

One of the most common types of necrosis. Appears due to failure/cessation of blood circulation in the arteries. The reason for this phenomenon is blockage of the lumens of blood vessels with blood clots, emboli, spasm of the walls of blood vessels. Inadequate blood supply to tissues leads to their death.

The location of necrosis can be the kidneys, lungs, brain, heart, intestines, and some other organs.

According to the damage parameters, total, subtotal infarction, and microinfarction are distinguished. Depending on the size of vascular necrosis, location, presence/absence of concomitant diseases, general health of the patient, symptoms, outcome of this disease will be different.

The disease in question, within the framework of laboratory studies, will manifest itself in the form of changes in the parenchyma and stroma.

Changes in the nucleus during necrosis

The nucleus of a pathological cell undergoes several stages of changes that follow one after another:

The parameters of the nucleus decrease, and chromatin shrinks inside it. If necrosis develops rapidly, this stage of nuclear deformation may be absent. Changes begin immediately from the second stage.

The nucleus breaks up into several fragments.

Total dissolution of the nucleus.

Changes in the cytoplasm during necrosis

The cytoplasm of a cell, in pathological phenomena that occur as a result of necrosis, has several stages of development:

All structures of the damaged cell die. In some cases, changes affect the cell partially. If destructive phenomena cover the entire cell, coagulation of the cytoplasm takes place.

The integrity of the cytoplasm is violated: it disintegrates into several lumps.

The cytoplasm melts completely (cytolysis), partially (focal necrosis). If the cell is partially melted, it may be restored in the future.

Changes in the intercellular substance during necrosis

Changes in this cell component cover several structures:

Under the influence of blood plasma proteins, this substance is deformed: it swells and melts.

At the initial stage of destruction, they change their shape (swell), break up into fragments, and then melt.

The algorithm of changes is similar to what happens when collagen fibers are destroyed.

Clinical and morphological forms of necrosis

Depending on the location of the pathology in question, the severity of its course, and possible consequences for the patient, several forms of necrosis are distinguished.

Coagulative or dry necrosis

With this form of the disease in question, dead tissue gradually dries out, decreasing in volume. A clear boundary is formed that separates pathological tissues from healthy ones. Inflammatory phenomena are observed at this border.

Dry necrosis occurs under the following conditions:

Lack of normal blood circulation in a small area of tissue. The physical properties of such fabric change: it becomes denser, drier, and pale gray in color.
The influence of chemical/physical factors on these areas.
Development of pathological phenomena in the considered form of necrosis. This phenomenon occurs in organs rich in proteins with limited fluid content. Often dry necrosis affects the myocardium, adrenal glands, and kidneys.
No infection within the affected area. The patient has no complaints of general malaise or fever.

Coagulation necrosis occurs among patients with errors in diet and a good protective reaction of the body.

Liquation or wet necrosis

Changes in tissue color in the affected tissue area.
Swelling of the pathological area, which is accompanied by inflammation.
The presence of bubbles that are filled with transparent (sometimes mixed with blood) liquid.
Discharge of purulent masses.
Rapid growth pathological cells, with further infection of the affected tissues. With wet necrosis, all body systems are affected, which is fraught with severe symptoms.

Colliquation necrosis develops against the background of the following factors:

Problems with blood circulation in a certain area. The cause may be thrombosis, embolism, or disruption of the integrity of the arteries.
The presence in the pathological area of tissues that have a considerable percentage of fluid content. Wet necrosis affects muscle tissue, fiber.
The patient has additional diseases (diabetes mellitus, rheumatoid arthritis, cancer), which negatively affects the body’s defense capabilities.

Gangrene as a type of necrosis

This type of necrosis often occurs after injury, due to the closure of the lumen of a blood vessel. The location of gangrene can be any internal organ, any tissue: intestines, bronchi, skin, subcutaneous tissue, muscle tissue.

It has a number of characteristic features:

Deformation of damaged tissue (complete loss of elasticity, firmness), change in its color (dark brown).
A clearly defined boundary between healthy and infected tissue.
Absence of any exacerbations. There are no special complaints from the patient.
Slow rejection of damaged tissue.
No infection. When pathogenic microorganisms enter the infected area, dry gangrene can develop into wet gangrene.

Wet.

It is often diagnosed in people who are predisposed to developing blood clots. Wet gangrene is a consequence of immediate blockage of a vessel, in which blood circulation is disrupted/stopped. All these phenomena occur against the background of total infection of the damaged tissue.

Signs of the type of gangrene in question:

Discoloration of deformed tissue (dirty green).
The presence of a strong, unpleasant odor at the site of gangrene development.
The appearance of bubbles filled with a clear/reddish liquid in the affected area.
Fever.
Nausea, vomiting, abnormal stool.

If there is an untimely response to this type of gangrene, the patient’s death may occur from intoxication.

Sequester as a type of necrosis

Often occurs and develops against the background of osteomyelitis. It is almost impossible to get rid of this type of necrosis: antibiotic therapy is ineffective.

There are several types of sequestration:

Cortical. The pathological phenomenon is localized on the surface of the bone, in soft tissues. In the presence of fistula passages, necrosis may leak out.
Intracavity. The cavity of the medullary canal is the environment where the products of sequestration rejection enter.
Penetrating. The location of the pathological phenomenon is the thickness of the bone. Soft tissues and the bone marrow canal are subject to the destructive effects of penetrating sequestration.
Total. Destructive processes cover large areas around the circumference of the bone.

Myocardial infarction or necrosis

The occurrence of this form of necrosis is associated with a long-term lack of adequate blood supply to a certain area of tissue.

There are several forms of myocardial necrosis:

Necrosis, which has a wedge shape, is often located in the kidneys, spleen, lungs: in those organs where there is a main type of branching of blood vessels.

Affects those internal organs where there is a mixed/scattered type of artery branching (heart, intestines).

Considering the volume of affected areas, myocardial necrosis can be of 3 types:

Subtotal. Individual zones of the internal organ are subject to destructive effects.
Total. The entire organ is involved in the pathological process.
Microinfarction. The extent of damage can only be judged through a microscope.

The appearance of the lesion during myocardial necrosis determines the presence of the following types of infarction:

White. The damaged area has a white-yellow color, which is clearly visualized against the general background of the tissue. Most often, white infarction occurs in the spleen and kidneys.
White with a red rim. The pathological area has a white-yellow color, with traces of hemorrhages. Characteristic of the myocardium.
Red. The necrosis zone has a burgundy color - a consequence of saturation with blood. The contours of the pathological area are clearly limited. Characteristic of the lungs and intestines.

Skin necrosis

In our age of technological and medical progress, people are still forced to deal with skin necrosis. 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.

Causes

Necrosis of the skin of the toes

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

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. Injuries, bruises, frostbite or exposure to ultraviolet rays provoke the formation of gangrene.
Allergic reactions can cause fibroid necrosis.
Trophoneurotic. With prolonged immobilization, blood microcirculation is 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

Ulcers due to skin necrosis

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, disruption of the digestive, nervous, genitourinary or respiratory systems may occur. Meanwhile, with necrosis, body temperature increases, severe weakness, swelling appears, and the heartbeat quickens.

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, a complete disruption of tissue metabolism occurs, 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 number of additional studies are prescribed. These include:

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

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

Therapy

Severe stage of necrosis

Treatment of the disease is carried out within the walls of a medical institution. We would like to note right away that necrosis cannot be cured at home, as well as with folk methods alone. 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 remove inflammatory process anti-inflammatory drugs are prescribed, and to destroy harmful bacteria– antibiotics.

Folk

No less useful will be ointments prepared with your 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 a warm compress to the affected area.

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

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 carry out a number of manipulations:

Preparation for surgery. Antibacterial therapy and infusion are carried out.
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.

Skin necrosis symptoms

Necrosis is necrosis, death of cells and tissues in a living organism, while their vital activity completely ceases.

The necrotic process goes through a series of stages :

paranecrosis - reversible changes similar to necrotic
necrobiosis – irreversible dystrophic changes (in this case, catabolic reactions predominate over anabolic ones)
cell death
autolysis - decomposition of a dead substrate under the action of hydrolytic enzymes and macrophages

Microscopic signs of necrosis:

1) Kernel changes

Karyopyknosis - shrinkage of the nucleus. At this stage, it becomes intensely basophilic—it turns dark blue with hematoxylin.
Karyorrhexis is the disintegration of the nucleus into basophilic fragments.
Karyolysis - dissolution of the nucleus

Pyknosis, rhexis and nuclear lysis occur sequentially one after another and reflect the dynamics of activation of proteases - ribonuclease and deoxyribonuclease. With rapidly developing necrosis, the nucleus undergoes lysis without the stage of karyopyknosis.

2) Changes in the cytoplasm

plasmacoagulation. First, the cytoplasm becomes homogeneous and acidophilic, then protein coagulation occurs.
plasmorrhexis
plasmolysis

Melting in some cases involves the entire cell (cytolysis), and in others only a part (focal liquefaction necrosis or balloon dystrophy)

3) Changes in the intercellular substance

a) collagen, elastic and reticulin fibers swell, saturated with plasma proteins, transform into dense homogeneous masses, which either undergo fragmentation, or lumpy decay, or are lysed.

The breakdown of fibrous structures is associated with the activation of collagenase and elastase.

Reticulin fibers do not undergo necrotic changes for a very long time, and therefore are found in many necrotic tissues.

b) the interstitial substance swells and melts due to depolymerization of its glycosaminoglycans and impregnation with blood plasma proteins

With tissue necrosis, their consistency, color and smell change. The tissue may become dense and dry (mummification), or it may become flabby and melted.

The fabric is often white and has a white-yellow color. And sometimes it is dark red when it is soaked in blood. Necrosis of the skin, uterus, and skin often becomes gray-green or black.

Causes of necrosis.

Depending on the cause of necrosis, the following types are distinguished:

1) traumatic necrosis

It is the result of direct action on the tissue of physical and chemical factors (radiation, temperature, electricity, etc.)

Example: when exposed to high temperatures, tissue burns occur, and when exposed to low temperatures, frostbite occurs.

2) toxic necrosis

It is the result of the direct action of toxins of bacterial and non-bacterial origin on tissue.

Example: necrosis of cardiomyocytes when exposed to diphtheria exotoxin.

3) trophoneurotic necrosis

Occurs when there is a violation of the nervous trophism of tissues. The result is a circulatory disorder, dystrophic and necrobiotic changes that lead to necrosis.

4) allergic necrosis

It is an expression of an immediate hypersensitivity reaction in a sensitized organism.

Example: Arthus phenomenon.

5) vascular necrosis– heart attack

Occurs when blood flow in the arteries is disrupted or stopped due to thromboembolism or prolonged spasm. Insufficient blood flow causes ischemia, hypoxia and tissue death due to the cessation of redox processes.

TO direct Necrosis includes traumatic and toxic necrosis. Direct necrosis is caused by the direct influence of a pathogenic factor.

Indirect necrosis occurs indirectly through the vascular and neuroendocrine systems. This mechanism of necrosis development is typical for species 3-5.

Clinical and morphological forms of necrosis.

They are distinguished, taking into account the structural and functional characteristics of the organs and tissues in which necrosis occurs, the reasons for its occurrence and the conditions of development.

1) coagulation (dry) necrosis

Dry necrosis is based on the processes of protein denaturation with the formation of sparingly soluble compounds that can long time do not undergo hydrolytic degradation.

The dead areas that appear are dry, dense, gray-yellow in color.

Coagulative necrosis occurs in organs rich in proteins and poor in fluids (kidneys, myocardium, adrenal glands, etc.).

Typically, a clear boundary between dead tissue and living tissue can be clearly marked. There is strong demarcation inflammation at the border.

Waxy (Zenker's) necrosis (in the rectus abdominis muscles in acute infectious diseases)

Caseous (cheesy necrosis) with syphilis, tuberculosis

Fibrinoid - necrosis of connective tissues, which is observed in allergic and autoimmune diseases. Collagen fibers and smooth muscles of the middle lining of blood vessels are severely damaged. It is characterized by the loss of the normal structure of collagen fibers and the accumulation of homogeneous necrotic material of a bright pink color, which is similar (!) to fibrin.

2) liquefaction (wet) necrosis

Characterized by the melting of dead tissue, the formation of cysts. It develops in tissues that are relatively poor in proteins and rich in fluid. Cell lysis occurs as a result of the action of its own enzymes (autolysis).

There is no clear zone between dead and living tissue.

Ischemic cerebral infarction

When masses of dry necrosis melt, they speak of secondary colliquation.

3) Gangrene

Gangrene is necrosis of tissues in contact with the external environment (skin, intestines, lungs). In this case, the tissues become gray-brown or black, which is associated with the transformation of blood pigments into iron sulfide.

a) dry gangrene

Necrosis of tissues in contact with the external environment without the participation of microorganisms. Most often occurs in the extremities as a result of ischemic coagulative necrosis.

Necrotic tissues dry out, shrink and harden when exposed to air, and are clearly demarcated from viable tissue. At the border with healthy tissues, demarcation inflammation occurs.

Demarcation inflammation– reactive inflammation around dead tissue, which delimits dead tissue. The restriction zone, accordingly, is a demarcation zone.

Example: - gangrene of the limb with atherosclerosis and thrombosis

For frostbite or burns

b) wet gangrene

Develops as a result of layering on necrotic tissue changes bacterial infection. Under the action of enzymes, secondary colliquation occurs.

The tissue swells, becomes swollen, and foul-smelling.

The occurrence of wet gangrene is promoted by circulatory and lymph circulation disorders.

With wet gangrene, there is no clear distinction between living and dead tissue, which complicates treatment. For treatment, it is necessary to transform wet gangrene into dry gangrene, only then carry out amputation.

Intestinal gangrene. Develops with obstruction of the mesenteric arteries (thrombi, embolism), ischemic colitis, acute peritonitis. The serous membrane is dull and covered with fibrin.

Bedsores. Bedsore is the death of superficial areas of the body that are subject to pressure.

Noma is a watery cancer.

c) gas gangrene

Occurs when a wound becomes infected with anaerobic flora. It is characterized by extensive tissue necrosis and the formation of gases as a result of the enzymatic activity of bacteria. Frequent clinical symptom– crepitation.

4) sequester

An area of dead tissue that does not undergo autolysis is not replaced connective tissue and is freely located among living tissues.

Example: - sequester in osteomyelitis. Around such a sequester a capsule and a cavity filled with pus will form.

5) heart attack

Vascular necrosis, a consequence and extreme expression of ischemia. The reasons for the development of a heart attack are prolonged spasm, thrombosis, arterial embolism, as well as functional stress of the organ in conditions of insufficient blood supply.

a) forms of heart attack

Most often, infarctions are wedge-shaped (the base of the wedge faces the capsule, and the tip faces the hilum of the organ). Such infarctions form in the spleen, kidneys, and lungs, which is determined by the nature of the architectonics of these organs - the main type of branching of their arteries.

Less often, necrosis has irregular shape. Such necrosis occurs in the heart, intestines, i.e. in those organs where non-main, scattered or mixed type branching of arteries.

b) magnitude

An infarction may involve most or all of an organ (subtotal or total infarction) or may be detected only under a microscope (microinfarction).

c) appearance

It is a white-yellow area, well demarcated from the surrounding tissue. Usually occurs in tissues with insufficient collateral circulation (spleen, kidneys).

It is represented by a white-yellow area, but this area is surrounded by a zone of hemorrhages. It is formed as a result of the fact that vascular spasm along the periphery of the infarction is replaced by their expansion and the development of hemorrhages. Such an infarction is found in the myocardium.

The area of necrosis is saturated with blood, it is dark red and well demarcated. It is found in those organs where venous congestion is characteristic, where there is no main type of blood supply. Occurs in the lungs (since there are anastomoses between the bronchial and pulmonary arteries), intestines.

Clinical manifestations of necrosis.

1) systemic manifestations: fever, neutrophilic leukocytosis. Intracellular enzymes are determined in the blood: the MB isoenzyme of kratin kinase increases with myocardial necrosis.

With a relatively favorable outcome, reactive inflammation occurs around the dead tissue, which separates the dead tissue from healthy tissue. In this zone, blood vessels dilate, plethora and swelling occur, and a large number of leukocytes.

Replacement of dead masses with connective tissue. In such cases, a scar forms at the site of necrosis.

Overgrowth of the area of necrosis with connective tissue.

Calcification. Accumulation of calcium salts in the capsule.

Extreme degree of petrification. Bone formation in the area of necrosis.

6) purulent melting

This is the purulent melting of infarcts during sepsis.

Symptoms of skin necrosis after surgery

Symptoms of skin necrosis

Skin necrosis is a pathological process that means the death of part of the tissue in a living organism. Swelling, denaturation and coagulation of cytoplasmic proteins and cell destruction occur.

The causes of skin necrosis are poor circulation and exposure to pathogenic bacteria or viruses. Based on etiology, they are classified into traumatic, toxigenic, trophoneurotic and ischemic necrosis.

Taking into account the structural and functional characteristics of organs and tissues, clinical and morphological forms of necrosis are divided into:

Coagulative necrosis (dry)

· Liquation necrosis (wet)

The cause of death of skin tissue can be physical or chemical trauma, allergic reactions, and innervation disorders. Post-infectious necrosis of the skin and subcutaneous tissue, bedsores are very serious, extremely unpleasant conditions. Bedsores appear as a result of constant pressure, poor circulation and the influence of the nervous system on nutrition and metabolism in the body, dry skin, insufficient care for a bedridden patient, anemia, etc.

Numbness, lack of sensitivity, pallor of the skin, and then cyanosis, blackening of the skin or the appearance of a dark green tint, general deterioration of the condition, increased heart rate, rise in temperature, hyperemia and swelling are the first signs of skin necrosis. If there is a rapid development of systemic manifestations and antibiotics are not effective, then this is also a sign of the presence of a necrotizing infection. Severe pain in the skin over the lesion warns of the development of gangrene.

Skin necrosis after surgery

Careful preparation before surgery and the use of modern methods ensure a significant reduction in the number of cases of skin necrosis, but no matter how careful compliance with sterility standards is, the risk group for complications after surgery includes patients suffering from diabetes, hypertension, and smokers. The first signs of necrosis are observed 2-3 days after surgery.

This is manifested by marginal necrosis along the suture. Having detected changes, it is necessary to preserve the crust covering the surface of the wound (eschar) for as long as possible, until granulations form under it. In the case of deeper tissue necrosis, when the suture diverges, necrectomy is performed, i.e., cleaning the edges of the wound with the help of enzyme gels and ointments, and after healing the wound, secondary sutures are applied.

The reasons for the formation of necrosis of a skin area after surgery may be a lack of blood supply, significant tissue detachment or tension at the suture sites, infection that develops as a result of the formation of a hematoma.

Treatment of skin necrosis

Necrotizing skin infections are caused by various microorganisms with aerobic and anaerobic properties. The disease occurs when a group of these pathogens penetrates the subcutaneous tissue. Their interaction leads to skin necrosis. Bacterial gangrene is caused by microaerophilic non-hemolytic streptococcus, and streptococcal gangrene is provoked by toxigenic strains of GABHS.

A rapidly progressing infection, accompanied by symptoms of severe intoxication. Human skin can be affected by necrotizing infections after insect bites, after minor injuries, when drug reactions occur, when injections are sterile, during paraproctitis (perianal abscesses) and many other factors. To date CT scan reliably confirms the presence of an infection causing skin necrosis.

Biopsy and aspiration biopsy allow diagnosis to be made by assessing histological changes. Treatment of patients with skin necrosis should be carried out under the supervision of doctors - an infectious disease specialist, a resuscitator and a surgeon. Intravenous therapy with penicillin, clindamycin and gentamicin is mandatory. Antibiotics are selected in accordance with the results of microbiological testing. And infusion therapy and hemodynamic stabilization are carried out.

For example, bacterial gangrene develops slowly and is therefore treated as an infectious form of gangrene. Treatment is conservative, but skin tissue affected by necrosis must be surgically removed. Pledge successful treatment skin necrosis - early diagnosis, intensive treatment medications and surgery.

Tissue necrosis: types and treatment

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

What is tissue necrosis

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

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

Causes

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

vascular – dysfunction of cardio-vascular system, which led to disruption of the blood supply to tissues, deterioration of blood circulation;
trophic - changes in the mechanism of cellular nutrition, disruption of the process of ensuring the preservation of the structure and functionality of cells (for example, skin necrosis after surgery, long-term non-healing ulcers);
metabolic – disruption of metabolic processes due to the absence or insufficient production of certain enzymes, changes in general metabolism;
allergic – a highly intense reaction of the body to conditionally safe substances, the result of which is irreversible intracellular processes.

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

mechanical – damage to tissue integrity (wound, trauma);
physical – impairment of functionality due to exposure to physical phenomena ( electricity, radiation, ionizing radiation, very high or low temperature - frostbite, burn);
chemical – irritation by chemical compounds;
toxic - damage by acids, alkalis, salts of heavy metals, drugs;
biological – destruction of cells under the influence of pathogenic microorganisms (bacteria, viruses, fungi) and the toxins they secrete.

Signs

The onset of necrotic processes is characterized by loss of sensitivity in the affected area, numbness of the limbs, and a tingling sensation. The deterioration of blood trophism is indicated by pallor of the skin. The cessation of blood supply to the damaged organ causes the skin color to become bluish and then acquire a dark green or black tint. General intoxication of the body manifests itself in deterioration of well-being, rapid fatigue, and exhaustion of the nervous system. The main symptoms of necrosis are:

loss of sensation;
numbness;
convulsions;
swelling;
hyperemia of the skin;
feeling of coldness in the extremities;
dysfunction of the respiratory system (shortness of breath, changes in breathing rhythm);
increased heart rate;
permanent increase in body temperature.

Microscopic signs of necrosis

The branch of histology devoted to the microscopic study of affected tissues is called pathohistology. Specialists in this field examine sections of organs to identify signs of necrotic damage. Necrosis is characterized by the following changes occurring in cells and intercellular fluid:

loss of the ability of cells to selectively stain;
core conversion;
discomplexation of cells as a result of changes in the properties of the cytoplasm;
dissolution, disintegration of the interstitial substance.

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

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

High prognostic value in case of skin necrosis of infectious origin, it has the morphology of leukocytes, for the study of which microscopic studies cytoplasm of affected cells. Signs characterizing necrotic processes may include the following changes in the cytoplasm:

plasmolysis – melting of the cytoplasm;
plasmorrhexis - disintegration of the cell contents into protein clumps; when filled with xanthene dye, the fragment under study turns pink;
plasmopyknosis – shrinkage of the internal cellular environment;
hyalinization - compaction of the cytoplasm, its acquisition of homogeneity and glassiness;
plasma coagulation - as a result of denaturation and coagulation, the rigid structure of protein molecules disintegrates and their natural properties are lost.

As a result of necrotic processes, connective tissue (intermediate substance) undergoes gradual dissolution, liquefaction and decay. Changes observed with histological studies, occur in the following order:

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

Types of necrosis

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

coagulation (dry) – develops in structures saturated with proteins (liver, kidneys, spleen), characterized by processes of compaction, dehydration, this type includes Zenker’s (waxy), adipose tissue necrosis, fibrinoid and caseous (curd-like);
colliquation (wet) - development occurs in tissues rich in moisture (brain), which undergo liquefaction due to autolytic breakdown;
gangrene - develops in tissues that come into contact with the external environment, there are 3 subtypes - dry, wet, gas (depending on the location);
sequestrum – is an area of dead structure (usually bone) that has not undergone self-dissolution (autolysis);
heart attack - develops as a result of an unexpected complete or partial disruption of the blood supply to an organ;
bedsores – formed when local violation blood circulation due to constant compression.

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

traumatic (primary and secondary) – develops under the direct influence of a pathogenic agent, according to the mechanism of occurrence it refers to direct necrosis;
toxigenic – occurs as a consequence of the influence of toxins of various origins;
trophoneurotic – the cause of development is disturbances in the functioning of the central or peripheral nervous system, causing disturbances innervation of the skin or organs;
ischemic – occurs when peripheral circulation is insufficient, the cause may be thrombosis, vascular blockage, low oxygen content;
allergic - appears as a result of a specific reaction of the body to external irritants; according to the mechanism of occurrence, it is classified as indirect necrosis.

Exodus

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

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

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

Diagnostics

It is not difficult for a histologist to identify necrotic changes of a superficial nature. Testing of blood and a sample of fluid from the damaged surface will be necessary to confirm the diagnosis, based on a verbal interview with the patient and visual inspection. If there is suspicion of gas formation with diagnosed gangrene, an x-ray will be prescribed. Necrosis of tissues of internal organs requires a more thorough and extensive diagnosis, which includes methods such as:

X-ray examination - used as a method of differentiated diagnosis to exclude the possibility of other diseases with similar symptoms, the method is effective in the early stages of the disease;
radioisotope scanning - indicated in the absence of convincing X-ray results, the essence of the procedure is the introduction of a special solution containing radioactive substances, which during scanning are clearly visible in the image, while the affected tissues, due to impaired blood circulation, will clearly stand out;
computed tomography – performed if bone tissue is suspected of dying; during diagnosis, cystic cavities are identified, the presence of fluid in which indicates pathology;
magnetic resonance imaging – highly effective and safe method diagnostics of all stages and forms of necrosis, with the help of which even minor cell changes are detected.

Treatment

Upon appointment therapeutic measures When tissue death is diagnosed, a number of factors are taken into account important points, such as the form and type of the disease, the stage of necrosis and the presence of concomitant diseases. General treatment of soft tissue skin necrosis involves taking pharmacological drugs to maintain the disease-depleted body and strengthen the immune system. For this purpose, the following types of drugs are prescribed:

antibacterial agents;
sorbents;
enzyme preparations;
diuretics;
vitamin complexes;
vasoconstrictors.

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

Problems and possibilities of restorative treatment of patients with necrosis of soft tissues and bones of the extremities

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

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

The onset of necrosis development is characterized by severe pain, the skin becomes pale and cold and takes on a marbled appearance. Numbness occurs and sensitivity is lost, function is impaired, although its manifestations are possible for some time after necrosis is established. Necrosis begins from the lower sections and gradually spreads to the level of malnutrition, and then a line called “demarcation” is determined at the border of dead and living tissues. The presence of demarcation indicates the possibility of performing an operation - removing the necrotic part along this line or above it. This long-established rule of tactics among surgeons is the only correct one that meets today's ideas.

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

Local treatment consists of removing necrosis within healthy tissue, and the extent of surgical intervention depends on the type of gangrene, which can be dry or wet. Dry disease proceeds favorably, and surgical intervention is indicated when a demarcation line is formed. In case of wet gangrene, when general manifestations are pronounced, accompanied by severe intoxication, immediate amputation of the limb is carried out within the limits of healthy tissue, that is, above the level of the necrosis border.

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

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

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

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

All patients had very severe damage with damage to soft tissues and bones, in 2 patients with closed fracture lower leg as a result of improper treatment (a circular plaster cast was applied), necrosis of the lower leg occurred, requiring necrectomy of the segment.

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

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

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

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

An example would be patient B., 26 years old.

While working on the press, my right hand got caught under it. The patient was taken to the surgical department of the district hospital.

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

Within several days, the phenomena of necrosis of the damaged area of the hand and signs of severe intoxication were clearly visible.

She was admitted to the regional hospital from the Central District Hospital, where she was offered amputation of the hand and the formation of a stump, in serious condition. The right hand on the back from the level of the wrist joint, on the palmar surface from the superior palmar groove, is necrotic. In the designated area, the skin is black, hard in places, all types of sensitivity are absent, and there is copious purulent discharge from under the scab and from the wound. When the scab is cut, there is no bleeding, but copious foul-smelling pus is released. The function of the hand is completely impaired. X-ray - no bone changes, culture of detritus for flora and sensitivity to antibiotics.

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

Operated. Catheterized brachial artery through a. Collateralis ulnaris superior and an infusion of penicillin 20 million units was started. as part of the infusate.

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

The deep flexor and extensor tendons are sutured over the end of the treated phalanges.

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

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

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

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

All patients experienced healing of the flap, some with signs of marginal necrosis, followed by wound healing on their own, or with the addition of a split skin flap.

A difficult subgroup of patients with tissue necrosis were patients with necrosis of deeper bone tissue.

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

It is known from practical surgery and scientific research (M.V. Volkov, V.A. Bizer, 1969; S.S. Tkachenko, 1970; M.V. Volkov, 1974; T.P. Vinogradova, G.I. Lavrishcheva, 1974; I.V. Shumada et al. 1985) that transplanted preserved bone allografts, which initially perform a fixing role, then turn into normal bone, and subsequently perform a stabilizing and functional supporting role.

The process of restoring bone to normal functional state depending on the properties of the graft is not the same. In particular, T. P. Vinogradova and G. I. Lavrishcheva (1974) in their fundamental work clearly differentiated regeneration activity depending on the characteristics of the graft. The most active in regeneration and effective in the treatment of patients with bone defects is an autograft, followed by frozen allograft, and then lyophilized.

These ideas forced us to think about the advisability of using an autograft as a plastic material, and its source should be a non-rejected necrotic fragment in severe open fractures of long bones of the extremities. This method was used in the treatment of 11 patients with severe injuries to the extremities with purulent complications and necrosis of soft tissues and bones.

An application for an invention was submitted and a patent was received for “METHOD FOR TREATING OPEN INFECTED FRACTURES WITH NECROSIS OF SOFT TISSUE AND BONES” No. 2002455, 1995.

inventions. Upon admission, the patient is examined. Conduct clinical, laboratory, bacteriological, functional, radiological and other types of studies.

The main artery is catheterized and antibiotics are administered as part of the infusate. After the elimination of inflammatory phenomena, necrotic soft tissue formations are excised. Fixation is ensured using proprietary fixators (extrafocal compression-distraction or rod devices) or immobilization using a plaster cast.

Bone fragments are processed to create contact - in the case of a transverse fracture in the end part, and in case of oblique fractures - according to its shape, but ensuring maximum contact of the bone fragments with fixation with the named fixators.

The existing soft tissue defect is replaced with a flap on a pedicle to lower limb-s the opposite leg, and for the upper limb - from the thoraco-abdominal region.

Once the flap has healed, 30 days after the defect is replaced, the feeding pedicle of the flap is cut off. Plaster immobilization or fixation with a compression-distraction device is carried out until complete consolidation.

An illustration of the application of the method is patient K., 35 years old.

Admitted three weeks after an open comminuted fracture of both bones of the right leg in middle third, with displacement of fragments.

Was treated in district hospital. Osteomyelitis of the right leg developed with tissue necrosis and a 6x8 cm defect with necrosis of the ends of fragments of the tibia and pin osteomyelitis of the calcaneus as a result of skeletal traction. Phenomena of general inflammatory reaction.

X-ray showed a spiral comminuted fracture of both tibia bones with displacement of the fragments.

Operated. The femoral artery was catheterized through the recurrent iliac artery. 10 million units introduced. penicillin. Necrectomy of soft tissues. The pointed nonviable ends of the proximal and distal fragments of about 1 cm were excised to create supportable congruence. On the sawdust of the bone there is no bleeding on both sides, the bone is white. Fragments were taken for research. The ends of the tibia fragments are devoid of periosteum about 5 cm above and below, the fragments are pale grayish in color.

Bone fragments are compared end to end and fixed using an Ilizarov apparatus.

Infusion of antibiotics for a week, and then plastic surgery of the soft tissue defect with covering of exposed fragments of the tibia with a cutaneous-subcutaneous-fascial-muscular flap cut from the opposite tibia.

The transplanted flap took root, the feeding pedicle was cut off after 32 days. The Ilizarov apparatus was removed after 2 months. A circular plaster cast is applied.

X-rays four months after the start of treatment showed that the fragments had healed. Wearing the leg is allowed.

Morphological study of bone tissue taken during excision of fragments.

Morphological picture of the state of bone tissue viability.

We studied 16 specimens taken from patients with open complicated fractures of long bones with necrosis of soft tissues and adjacent bone.

Fragments of the proximal and distal fragments of the broken bone were taken. Fixed in 12% neutral formalin solution. After decalcification in a 5% nitric acid solution and encapsulation in celloidin, sections were made and stained with hematoxylin and Van Gieson.

The bone tissue is devoid of osteocytes, in some places it has a homogeneous structure, and the bonding lines are not contoured. Tinctorial properties are sharply impaired. Zones of basophilia alternate with areas of oxyphilic staining. In some places, areas of complete necrosis of bone tissue (melting bone) are visible. The process of osteogenesis is not expressed. Between areas of necrotic bone in some preparations, the formation of scar tissue is visible, in which lymphoid infiltrates with the presence of plasma cells can be traced.

Due to the non-standard tactical and surgical decisions, we will dwell in more detail on the discussion of patients in this group.

Two patients were admitted with obvious necrosis of the leg, and one with necrosis of the forearm. There were no doubts about the actions; the plans were to preserve the knee joint in case of damage to the lower leg and elbow joint with damage to the forearm, which was quite successful.

All patients operated on using the proposed method experienced consolidation of bone fragments and restoration of function of the leg or arm, depending on the initial damage to the limb. Most importantly, the necrotic bone was not excised. She played the role of an autograft. Thus, the treatment time for patients was reduced several times compared to traditional ways treatment, even with the method of bilocal osteosynthesis, recognized as the most progressive in our time, with all the possibilities of which it takes at least two years to correct the length of a limb segment with a bone defect of 10 cm.

If you want to become more familiar with traumatological and orthopedic problems and the possibility of solving them, you can order books that reflect our experience.

Skin necrosis is a dangerous pathology in which some tissue in the body dies. Necrosis develops as a result of circulatory disorders, and also due to the fact that viruses and bacteria negatively affect the skin. Several types of necrosis can be defined: toxigenic, traumatic, ischemic, trophoneurotic. It all depends on the characteristics of the structure of tissues and organs. How to properly treat the disease? Is it dangerous?

Causes

Pathology can develop subsequently, myocardial infarction, and also due to bedsores. The skin is affected due to physical, chemical injuries, during allergies. No less dangerous are post-infectious necrosis and bedsores. They appear due to impaired blood circulation, metabolism, and failure to comply with basic hygiene rules by bedridden patients.

Necrosis can develop after an injection, when a large dose of medication is administered; subsequently, arteriolospasm first occurs, and over time, tissue hypoxia. Is it possible to prevent skin necrosis? In this case, the drug + Novocaine is administered. You can also apply cold to the injection site.

Symptoms

To find out about necrosis in a timely manner, a computed tomography scan is performed. The doctor plays it safe and always suggests doing a biopsy to determine histological changes.

Attention! Patients with necrosis are examined by a surgeon, resuscitator, and infectious disease specialist.

Be sure to carry out intravenous therapy using Gentamicin, Clindamycin, Penicillin. Additionally, antibacterial drugs are prescribed after microbiological examination and infusion therapy.

Bacterial gangrene develops slowly, so conservative treatment methods are used initially, then the affected skin is removed through surgery. The sooner the disease is diagnosed, the better for the patient.

In addition, the following treatment methods are required:

Treatment of the affected tissue with a solution of potassium permanganate and brilliant green.
Bandages are applied to the affected skin, which are pre-moistened in Chlorhexidine and Ethyl alcohol.

To cure dry necrosis, the cause is first eliminated, special medications are used, and an operation is performed during which blood circulation is restored.

If the patient has wet necrosis, a slightly different treatment is prescribed:

Local procedures.
Wounds are treated with Hydrogen Peroxide.
Swelling is drained.
Antiseptic dressings are used.
Plaster splints are used.

Medicines are used to prevent intoxication of the body. To get rid of pain, anti-inflammatory drugs are prescribed. By using medicine the muscles relax, so blood flow can be restored. In this case, Diclofenac, Nimulid, Ketoprofen are prescribed.

To improve blood circulation, it is necessary to take vasodilators. Attention! Be extremely careful with these medications if you have previously had a heart attack or stroke.

If necrosis affects bone tissue, chondroprotectors are prescribed. With their help, you can restore cartilage tissue. Medicines must be taken at a late stage of the disease. The non-traditional method of treatment with leeches helps a lot. Due to the fact that leeches release enzymes into the body, blood circulation improves.

With necrosis, massage is indispensable. The main thing is that it is not rough, does not lead to discomfort or pain, otherwise your health will worsen. IN complex therapy included ozokerite, laser, mud treatment. These methods do an excellent job of treating necrosis of the hip joint.

On a note! To prevent muscles from atrophying, you need to perform a special set of exercises, after consulting with your doctor.

So, necrosis occurs quite often. As a rule, it is very difficult to save a person, because everything ends in gangrene, sepsis and other unpleasant consequences. Pay close attention to your health!