Symptoms of skin necrosis after surgery
Skin necrosis symptoms
Skin necrosis is a pathological process that means the death of a part of tissue in a living organism. Swelling, denaturation and coagulation of cytoplasmic proteins and cell destruction occurs. The causes of skin necrosis are poor circulation and exposure to pathogenic bacteria or viruses. By etiology, they are classified into traumatic, toxigenic, trophoneurotic and ischemic necrosis.
Considering the structural and functional features of organs and tissues, clinical and morphological forms of necrosis are divided:
Coagulative necrosis (dry)
Colliquation necrosis (wet)
Caseous necrosis
Sequestration
·Gangrene
Heart attack
Bedsores
The reason for the death of skin tissue can be physical or chemical injuries, allergic reactions, and disturbances in innervation. Post-infectious necrosis of the skin and subcutaneous tissue, bedsores are very serious, extremely unpleasant conditions. Bedsores appear as a result of constant pressure, circulatory disorders and the influence of the nervous system on nutrition and metabolism in the body, dry skin, inadequate care of the bedridden patient, anemia, etc.
The appearance of necrosis after injections is explained by the introduction of very large doses of the drug, after which reflex arteriolospasm develops, and then tissue hypoxia. To prevent the development of post-injection necrosis of the skin, a solution of novocaine should be injected simultaneously with the drug and cold should be applied to the injection area.
Numbness, lack of sensitivity, pallor of the skin, and then cyanosis, blackening of the skin or the appearance of a dark green hue, general deterioration, increased heart rate, fever, hyperemia and swelling are the first signs of skin necrosis. If there is a rapid development of systemic manifestations and taking antibiotics is 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 the operation, the use of modern methods provide a significant reduction in the number of cases of skin necrosis, but nevertheless, no matter how careful the observance of sterility standards, the risk group for complications after surgery includes patients suffering from diabetes mellitus, hypertension, and smokers. The first signs of necrosis are observed 2-3 days after surgery.
This is manifested by marginal necrosis along the seam. Having found changes, it is necessary to preserve the crust covering the surface of the wound (scab) as long as possible, before the formation of granulations under it. In the case of deeper tissue necrosis, when the suture diverges, necrectomy is performed, that is, the edges of the wound are cleaned with the help of enzymatic gels and ointments, after the wound is tightened, secondary sutures are applied.
The reasons for the formation of necrosis of the skin area after the operation may be a lack of blood supply, significant tissue detachment or tension in the suture areas, 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 into 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 an insect bite, after minor injuries, in the event of drug reactions, violation of the sterility of the injection, with paraproctitis (perianal abscesses) and many other factors. To date, computed tomography reliably confirms the presence of an infection causing skin necrosis.
Biopsy and aspiration biopsy allows for diagnosis by evaluating histological changes. Treatment of patients with skin necrosis should be carried out under the supervision of doctors - infectious disease specialist, resuscitation specialist and surgeon. Intravenous therapy with penicillin, clindamycin and gentamicin is mandatory. Antibiotics are selected in accordance with the results of microbiological research. 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 prescribed conservatively, but necrotic skin tissues must be surgically removed. The key to successful treatment of skin necrosis is early diagnosis, intensive medication and surgical intervention.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
