necrosis

The term derived from the Greek necrosis describes the death of individual cells or cell groups in the living organism, which can lead to the death of tissue layers and ultimately also of limbs. In contrast, there is apoptosis, which is a physiological cell death.

What is necrosis?

The pathological death of individual cells, tissues or limbs is called necrosis designated. In humans, necrosis manifests itself depending on the type of tissue involved. Solid yellow foci of necrosis can be found in the protein-rich tissues of the heart and spleen or the gastrointestinal tract.

In tissue poor in protein, the necrosis causes liquefaction. Gangrene can develop as a secondary phenomenon. A distinction is made here between two types of gangrene. Dry gangrene develops when a necrosis dries up under the influence of air, turns black or blue-black and hardens.

Bacteria lead to the development of moist gangrene and trigger a putrid smell and a damp, mushy consistency change in the necrosis.

causes

One necrosis there is always an underlying inflammation, which ultimately leads to the death of the affected cells and tissue. This inflammation can be triggered by various environmental influences or a lack of nutrients or oxygen.

Circulatory disorders can also result in necrosis. These factors can trigger the death of individual cells, which can ultimately provoke an inflammatory response in the surrounding tissues. As a result, phagocytes are attracted to the focus of inflammation, which release inflammatory messenger substances.

As a result, apoptosis usually occurs as a co-phenomenon of necrosis. Secondary gangrene can also be triggered by bacteria. It is particularly common in extremities with poor blood circulation. In addition, this consequence of necrosis can also accompany arterial occlusive diseases.

Symptoms, ailments & signs

The main symptom of necrosis is cell death. The necrosis can be small or large. It can be superficial and affect the skin, or it can mean cell death in the internal organs. Necrosis on and in the skin is also quickly visible. The necrosis shows up as black and yellow discoloration. Inflammation occurs before or after cell death occurs.

Correspondingly, the areas can also redden, swell, pain or lead to a feeling of warmth. The inflammation usually persists around the dying part and can thus create a feeling of tension. Necrosis can also lead to restricted mobility if it occurs in the bones and joints.

Bacteria and other organisms can liquefy the dead tissue and thus lead to the release of pus and wound fluids. In many cases, the sensitivity is reduced in the dying areas. The whole body becomes involved due to the dissolved tissue and the bacteria.

Those affected experience chills, severe fever, nausea and a strong feeling of illness. These symptoms occur more quickly, especially when internal organs are affected by the necrosis. In addition, affected organs can also show various symptoms as a symptom.

Diagnosis & course

Diagnosing a necrosis is based on a comprehensive anamnesis. Furthermore, the physiological examination and assessment of the affected tissue, including checking the pulse and blood flow, is carried out.

Imaging procedures support the diagnostic process. Depending on the type and progression of the necrosis, it can be identified by the nature of the necrotic focus, which varies depending on the tissue affected. The healing of the necrosis also depends on the type of tissue. Protein-rich intestinal cells, for example, can regenerate so that the necrosis is overcome by cell regrowth.

Further examinations and tissue analyzes clarify the exact type of necrosis. Here is i.a. A distinction was made between coagulation necrosis, adipose tissue necrosis, armor necrosis, phosphorus necrosis, as well as cheese formation and tumorous necrosis.

Complications

Necrosis can have very different complications and symptoms. However, these depend heavily on the cause and the affected region in the body, so that a general prediction is usually not possible. Furthermore, necrosis leads to disturbances of the blood circulation, so that internal organs can possibly be damaged by this disease. The patient's quality of life is significantly reduced due to the illness.

Scars can also develop due to the necrosis and thus negatively affect the aesthetics of the person concerned. Usually necrosis can be treated relatively easily.In most cases, there are no particular complications. In many cases, the body's own reaction to this disease also leads to self-healing.

Furthermore, the affected person is dependent on a healthy lifestyle and a healthy diet in order to prevent the symptoms of necrosis. Successful treatment does not reduce the quality of life. Necrosis can also be prevented if appropriate medication is taken after radiation therapy. There are usually no complications.

When should you go to the doctor?

If signs of necrosis are found, it is imperative to seek medical advice. People who notice unusual, mostly black and yellow discoloration of the skin, should consult a doctor. At the latest when the affected areas swell or cause pain, a doctor must determine the cause and, depending on the findings, initiate treatment.

People with circulatory disorders or bacterial infections are particularly prone to developing necrosis. People who are exposed to harmful environmental influences over a long period of time or who suffer from an eating disorder also belong to the risk groups and should immediately seek medical advice if the symptoms described above appear.

Treatment is carried out by your family doctor or a dermatologist. Depending on the cause, other internists and alternative specialists such as alternative practitioners or physiotherapists can be called in. Affected children should be presented to the pediatrician if strange skin changes and other symptoms are noticed that suggest a serious condition. In severe cases, the necrosis must be treated surgically.

Treatment & Therapy

Treating a necrosis takes into account their natural healing process, which can be divided into inflammation and infection phases, resorption, regeneration and scarring.

Accordingly, the bacterial infection should be fought, for example, by the administration of antibiotics, regeneration and thus wound healing should be stimulated and scarring should be reduced. The primary goal of treatment is to restore the necrotic tissue to the status of a fresh wound and to prevent the inflammation from spreading.

In addition to the operation, lysis or the use of catheters can achieve this wound status. On the other hand, tissue that has already died is removed so that the necrosis does not spread. In addition, when treating necrosis, care must be taken to continuously improve the blood flow to the affected tissue and to stimulate new tissue formation. Various factors for tissue blood flow must be taken into account, including include the positioning of the patient and the affected limbs, a constant warm body temperature as well as muscle work and muscle training.

As an alternative to tissue regeneration, however, necrotic tissue can also be replaced by scarring from another type of tissue. In addition to the body's own reactions that can lead to healing, necrosis can be treated pharmacologically.

Outlook & forecast

The prognosis for necrosis can be very different. This depends on the localization, the size and any germs. Overall, necroses contaminated with bacteria or other germs become larger and more serious if left untreated. On the other hand, necroses that have been cleaned and are inaccessible to pathogens can be partially healed by the body itself. However, this is only rarely the case and then affects a superficial pressure ulcer or necrosis that is not deep as a result of a burn.

Necrosis caused by pathogens or massive tissue damage tends to spread. There is also the risk of sepsis, especially with internal tissue retreats. In addition, important organs can be affected. If left untreated, the condition of those affected usually worsens. Internal necrosis quickly becomes life-threatening even with treatment.

Treated necrosis, which includes the removal of dead tissue, has different chances of healing. The patient's size, location, and general health are factors that greatly affect wound healing. Elderly and bedridden people survive this ailment less well than young, well-nourished and moving people. Necrosis can take weeks or months to heal.

prevention

Of the necrosis can be prevented on the one hand by avoiding harmful environmental factors and on the other hand by improving physical conditions. The environmental influences to be avoided include bacteria, poisons and other pollutants. Continuous malnutrition and the abuse of alcohol and drugs can also lead to necrosis. Necrosis as a result of radiation therapy can be prevented with anti-inflammatory drugs.

Aftercare

After surgical treatment of the necrosis, the wound is checked daily for signs of inflammation. The treating doctor selects the dressing material and arranges it on the basis of a prescription. Further aftercare of the patient can be carried out at home by qualified nursing staff. The affected area of ​​skin must be positioned freely and, if possible, high.

The follow-up of the necrosis also consists of follow-up controls, which observe and describe the wound healing. It is possible that other dressing materials are required in order to achieve better healing results.

Monitoring the wound for signs of inflammation (reddening, warming, evidence) is particularly important during follow-up care for necrosis. If a wound infection is suspected, it is necessary to take a blood sample in order to check the laboratory parameters and, if necessary, take medication.

A final check is carried out by the doctor after the necrosis has completely healed. The patient receives sufficient information from the doctor or an appropriately trained nurse. He learns how he can prevent necrosis from developing in the future. Especially with bedridden people, it is important to keep the extremities free and to allow appropriate skin care and the supply of sufficient fluids. Successful long-term follow-up care for necrosis requires good skin care and good observation so that this can be avoided in the future.

You can do that yourself

Patients suffering from necrosis can support the healing process with a few measures and various means from the household and nature. Increased personal hygiene prevents the affected area from becoming infected. Perfumed shampoos and care products must not be used in the first few days. Natural shampoos made from coconut oil or arnica are a good alternative. Patients should discuss the use of any skin care products with their dermatologist.

Massage can help if scars form in the course of recovery. If the skin changes persist, talking to friends and relatives, but also with a therapist, can help to overcome the emotional complaints. If, in spite of all the measures, further complaints arise or other body areas are discovered that have died, a doctor must be consulted. The mentioned preparations should only be used with the consent of the doctor. In addition, care and bed warmth apply.

Swollen areas of skin can be cooled with cooling pads. Special creams from specialist retailers, but also a paste made from sage and olive oil, help with itching and abnormal sensations. This is applied to the affected area and inhibits the inflammatory processes.