The term necrosis, which comes from the Greek, describes the death of individual cells or cell clusters on a living organism, which can result in the death of tissue layers and eventually limbs. This contrasts with apoptosis, which is physiological cell death.
What is necrosis?
The pathological death of individual cells, tissues, or limbs is called necrosis. In humans, necrosis manifests depending on the type of tissue affected. Solid yellow foci of necrosis are found in the protein-rich tissues of the heart and spleen or the gastrointestinal tract. In tissues low in protein, necrosis triggers liquefaction. As a secondary phenomenon, gangrene formation may occur. Two types of gangrene are distinguished here. Dry gangrene occurs when a necrosis dries up under the influence of air, turns black or blue-black, and hardens. Bacteria lead to the development of wet gangrene and cause a foul odor and a moist slushy consistency change in the necrosis.
Causes
Necrosis is always caused by inflammation, which eventually leads to the death of the affected cells and tissues. This inflammation can be triggered by various environmental factors 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 eventually provoke an inflammatory response in the surrounding tissues. As a result, phagocytes are attracted to the site of inflammation, releasing inflammatory messengers. Thus, apoptosis usually also occurs as a cophenomenon of necrosis. Secondary gangrene can also be triggered by bacteria. It occurs particularly frequently in extremities with poor blood supply. In addition, this sequela of necrosis may accompany arterial occlusive disease.
Symptoms, complaints, and signs
The main symptom in necrosis is cell death. The necrosis may be small or large in area. It may be superficial and affect the skin, or it may involve cell death of internal organs, for example. Necrosis on and in the skin is also quickly visible. Necrosis shows up as black and yellow discoloration. Inflammation occurs before or after the appearance of cell death. Accordingly, the areas may also become red, swollen, painful or cause a sensation of warmth. Inflammation usually persists around the dying part, which can cause a feeling of tightness. Necrosis can also cause limited motion when it occurs on bones and joints. Bacteria and other organisms can liquefy the dead tissue parts, leading to the release of pus and wound fluids. In many cases, sensitivity is reduced at the dying sites. Due to the dissolved tissue parts and the bacteria, there is involvement of the entire body. Sufferers experience chills, severe fever, nausea and a strong feeling of illness. Especially when internal organs are affected by necrosis, these symptoms occur more quickly. In addition, affected organs may also show various failure symptoms as a symptom.
Diagnosis and course
The diagnosis of necrosis is based on a comprehensive history. Furthermore, physiologic examination and assessment of affected tissues, including examination of pulse and blood flow, are performed. Imaging techniques aid in the diagnostic process. Depending on the type and progress of necrosis, it can be identified by the texture of the necrosis lesion, which varies depending on the tissue affected. Healing of the necrosis also depends on the tissue type. Protein-rich intestinal cells, for example, can regenerate so that the necrosis is overcome by regrowth of the cells. Further examinations and tissue analyses clarify the exact type of necrosis. Here, a distinction is made between coagulation necrosis, adipose tissue necrosis, armor necrosis, phosphor necrosis, and caseation and tumor necrosis, among others.
Complications
Necrosis can present with a wide variety of complications and symptoms. However, these depend greatly on the cause and on the affected region in the body, so a general prediction is usually not possible. Furthermore, however, necrosis leads to disturbances in blood flow, so that internal organs may possibly be damaged by this disease.The patient’s quality of life is significantly reduced due to the disease. Scars can also form due to the necrosis and thus negatively affect the aesthetics of the affected person. As a rule, necrosis can be treated relatively easily. In most cases, there are no particular complications. Due to the body’s own reaction to this disease, self-healing also occurs in many cases. Furthermore, the affected person is dependent on a healthy lifestyle and a healthy diet to prevent the symptoms of necrosis. With successful treatment, there is no reduction in the quality of life. Likewise, necrosis can be prevented if appropriate medication is taken after radiation therapy. In this case, complications usually do not occur as well.
When should you see a doctor?
If signs of necrosis are noted, it is imperative to seek medical attention. People who notice unusual discoloration of the skin, usually black and yellow, are best to consult the doctor. At the latest, if the affected areas swell or cause pain, a medical professional must determine the cause and, depending on the findings, initiate treatment. People suffering from circulatory disorders or bacterial infection are particularly susceptible to the development of necrosis. People who have been exposed to harmful environmental influences over a longer period of time or suffer from an eating disorder also belong to the risk groups and should seek medical advice immediately with the described signs. Treatment is carried out by the family doctor or a dermatologist. Depending on the cause, other internists as well as alternative specialists such as alternative practitioners or physiotherapists may be consulted. Affected children should be presented to the pediatrician if strange skin changes and other symptoms are noticed that indicate a serious condition. In severe cases, necrosis must be treated surgically.
Treatment and therapy
Treatment of necrosis takes into account its 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 administering antibiotics, regeneration and thus wound healing should be stimulated, and scar formation should be reduced. Thus, the primary goal of treatment is to restore the necrotized tissue to the status of a fresh wound and prevent the spread of inflammation. In addition to surgery, lysis or the use of catheters can achieve this wound status. Already dead tissues, on the other hand, are ablated so that necrosis does not spread. In addition, when treating necrosis, care must be taken to continuously improve blood flow to the affected tissues and stimulate new tissue formation. In this regard, various factors for tissue perfusion should be considered, which include positioning of the patient and affected limbs, a constant warm body temperature, and muscle work and muscle training. However, as an alternative to tissue regeneration, a necrotic tissue can be replaced by scarring of another type of tissue. In addition to endogenous responses that can lead to healing, necrosis can be treated pharmacologically.
Outlook and prognosis
The prognosis can vary widely for necrosis. This depends on the location, size, and any germs. Overall, necrosis contaminated with bacteria or other germs will always become larger and more serious if left untreated. Cleaned necroses that are not accessible to pathogens, on the other hand, can be healed well by the body itself in some cases. However, this is rarely the case and then concerns, for example, a superficial decubitus or a non-deep necrosis resulting from a burn. Necrosis caused by pathogens or massive tissue damage tends to spread. There is also a risk of sepsis, especially with internal tissue breakdown. In addition, important organs can be affected. If left untreated, the condition of the affected person usually deteriorates. Internal necrosis quickly becomes life-threatening even with treatment. Treated necrosis, which includes removal of dead tissue, has varying prospects for healing. The size, location, and general health of the patient are factors that greatly affect wound healing.Elderly and bedridden people are less likely to survive this condition than young, well-fed and moving people. Necrosis can take weeks and months to heal.
Prevention
Necrosis can be prevented first by avoiding harmful environmental factors and second by improving physical conditions. Environmental factors to be avoided include bacteria, toxins, and other pollutants. Continuous malnutrition and abuse of alcohol and drugs can also lead to the occurrence of necrosis. Necrosis resulting from radiation therapy can be prevented by anti-inflammatory medications.
Aftercare
After surgical therapy for necrosis, the wound is checked daily for signs of inflammation. The dressing material is selected by the attending physician and ordered by prescription. Further follow-up of the patient can be done at home by certified nursing staff. The affected skin area must be kept free and, if possible, elevated. Further aftercare of the necrosis consists of progress controls, which observe and describe the wound healing. It is possible that other dressing materials may be required to achieve a better healing result. Particularly important in the follow-up of necrosis is wound monitoring with respect to signs of inflammation (redness, heating, evidence). If a wound infection is suspected, it is necessary to perform a blood draw to check laboratory parameters and intervene with medication if necessary. A final check after complete healing of the necrosis is performed by the physician. The patient receives sufficient information from the physician or an appropriately trained nurse. He learns how to avoid the development of necrosis in the future. Especially in bedridden people, it is important to keep the extremities exposed and to provide adequate skin care and fluid intake. Successful long-term follow-up for necrosis occurs with good skin care and good observation skills so that it can be avoided in the future.
Here’s what you can do yourself
Patients suffering from necrosis can support the healing process with some measures and various household and natural remedies. Increased personal hygiene will prevent the affected area from becoming inflamed. In the first few days, do not use perfumed shampoos and care products. Natural [[shampoo[[s made from coconut oil or arnica are a good alternative. Patients should discuss the use of any skin care products with their dermatologist. If scars form during recovery, massages may help. In the case of permanent skin changes, talking to friends and relatives, as well as to a therapist, can help to overcome the psychological discomfort. If, despite all measures, further discomfort develops or other areas of the body are discovered to be dead, a doctor must be consulted. The mentioned preparations should be used only with the doctor’s approval. In addition, rest and bed warmth apply. Swollen skin areas can be cooled with cooling compresses. In the case of itching and discomfort, special creams from specialist shops can help, as can a paste made from sage and olive oil. This is applied to the affected area and inhibits the inflammatory processes.
