Necrosis

Description:

The necrosis (necrosis) - local death of cells, fabrics or bodies in a live organism, death can come from direct destruction by the injuring agent, from a circulatory disturbance or disturbance of a trophicity.

Necrosis symptoms:

Clinical options not rose:
    * Coagulative necrosis (dry)
    * Kollikvatsionny necrosis (wet)
    * Caseous necrosis
    * Sequester (medicine)
    * Gangrene
    * Heart attack
    * Decubituses

Necrosis reasons:

The factors leading to a necrosis happen: mechanical, thermal, electric, chemical, toxic, beam, etc.

Impact on cells, fabrics and bodies of the mechanical force exceeding the resilience of covers leads to their razmozhzheniye, gaps, etc. Temperature of over +60 градусовС or below - 15 градусовС causes burns, freezing injuries. In places of an entrance and exit from an organism of a current of high voltage  very high temperature develops, on a body there are "current signs" - the fabric burned in these parts.

Chemical action. Strong acids, coagulating proteins of cells, cause a dry necrosis. Strong alkalis, dissolving proteins and saponifying fats, lead to development of kollikvatsioppy necroses of fabrics (that and another - corrosive burns). Microbic toxins can also lead to a necrosis of cells, fabrics (for example, anaerobic gangrene of an extremity, etc.).

The circulatory disturbances causing necrosis of fabrics or bodies are caused by the following reasons: a) disturbance of cordial activity, its easing (decompensation, embolisms); b) a long spasm or an obliteration of vessels (an angiosclerosis at senile gangrene, obliterating also atherosclerosis, gangrene at poisoning with an ergot chpdarteriit, etc.); c) it is squeezed or wound of a vessel (a gut necrosis at the restrained hernia, extremity gangrene at timely not removed plait or excessively pressure plaster bandage); d) the disturbance of chemism of blood leading to thrombosis of the main vessel in the absence of enough developed collaterals (fibrinferments, embolisms).

Circulatory disturbances and the subsequent necroses often define the course of surgical and other diseases. So, the necrosis of fabrics plays a large role in development of clinic of anaerobic gangrene, an obliterating endarterint, gangrenous appendicitis, cholecystitis, acute pancreatitis, impassability of intestines, the restrained hernias, a perforatipny yazpa of a stomach, etc.

Disturbances of a trophicity of fabrics can also lead to omertveniye even at the most insignificant external influences. Bystry development of decubituses on a body can be an example at injuries of a spinal cord.

Treatment of the Necrosis:

Elements of complex treatment are improvement of the general condition of the patient, stimulation of immunobiological forces and regenerative properties, symptomatic therapy, remedial gymnastics.

Necrotic fabrics or body are subject to operational removal. An exception of this rule are separate types of a necrosis: a necrosis at which the operational risk is higher, than risk of an outcome of a preoperative state (for example, a myocardial infarction), a small heart attack, the encapsulated necrosis with a tendency to the organization or transformation in an ulcer, a cyst.

At a coagulative necrosis, dry gangrene operation can be postponed until a full otgranicheniye of necrotic fabrics. At the same time prevention of development of a kollikvatsionny necrosis (wet gangrene) therefore topical conservative treatment of a dry necrosis is carried out at strict observance of an asepsis with use of the drying means is important: an open method of treatment, influence by warm air (24 — 25 °C) under the metal framework with bulbs covered with a sterile sheet, greasing of fabrics solutions of 1% of diamond green, 5% of iodine, 10% of potassium of permanganate or silver of nitrate, 5% of a tannin, use of spirit bandages, physiotherapeutic procedures (Ural federal district, UVCh, etc.). After emergence of a line of demarcation make a necrotomy (a necrosis section), a necretomy (removal of a necrosis) or amputation.

The necrotomy is carried out at extensive necroses of an extremity and thorax as a necrosis, breaking an innervation, krovo-and the lymphokinesis, worsens food of glubzhelezhashchy fabrics (or extremities at a circular necrosis) and complicates breath. Necrotic fabrics cut to the bleeding viable fabrics in several places often without anesthesia (necrotic fabrics are painless).

The necretomy (excision of devitalized fabrics) is carried out within viable fabrics after emergence of a line of demarcation or after delimitation of a necrosis by means of mechanical irritation (a prick by a needle from the syringe, a contact with a surgical instrument, a ball, etc.). The defect of fabric formed after a necretomy is closed suture or a dermatoplasty.

Amputation of an extremity or its segment is carried out by force according to vital indications (transformation of dry gangrene in progressing wet, sepsis). At a kollikvatsionny necrosis, wet gangrene it is necessary to try to transfer them to a dry state the drying means. Inefficiency of these actions and the progressing wet necrosis with intoxication are indications to the emergency or urgent necretomy, amputation within viable fabrics. At wet gangrene of internals operation is always performed in the emergency order.