What Is Necrosis?

Medically Reviewed By Meredith Goodwin, MD, FAAFP
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Necrosis is the medical term for when cell or body tissue dies prematurely. Death of the living tissue occurs when blood stops flowing to the tissue. This is usually from injury, trauma, or disease. Necrosis is irreversible. When large areas of body tissue begin to die, this is known as gangrene. You must remove the damaged and dying tissue.

This article will explain what necrosis is. It will also describe the symptoms, causes, and treatment options for the condition.

What is necrosis?

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Necrosis is uncontrollable cell death. It is irreversible and results in the swelling of all cell parts. The cell eventually ruptures and spills the intracellular contents into the surrounding tissue leading to tissue damage.

Is necrosis the same as infarction?

The difference between infarction and necrosis can be confusing as, they seem similar.

Infarction means a lack of blood to cells. It can result from a blocked artery, mechanical compression, or vasoconstriction.

A symptom of infarction is usually pain. However, other symptoms will differ depending on the area where this infarction occurs, such as a heart attack, stroke, and spinal cord loss of movement.

Infarction involves the blockage of a blood vessel by a clot. The size of the clot determines the diameter of the blood vessel that becomes blocked. Any tissue that depends on the blood beyond the blockage is affected. This can be a heart vessel, a lung vessel, or any other vessel. For small vessels out of reach of surgery, a doctor may prescribe blood thinners.

Treatment for infarction involves surgery to restore blood flow and antibiotics. Possible infarction complications include rupture of a blood vessel, which can be fatal. In addition, if the blood vessels heal, scar tissue can cause long-term issues.

Read more about gangrene here.

What are the symptoms of necrosis?

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The signs and symptoms of necrosis can differ with the exact type. Generally, the symptoms can include:

  • pain
  • dusky, purple discoloration occurring several hours after tissue death
  • coolness from a lack of blood supply
  • numbness
  • loss of sensation
  • abnormal sensations, such as burning, tingling, or prickling
  • skin discoloration, appearing red, white, or black for gangrene
  • blisters filled with blood or clear liquid

How long does it take to develop?

The rate the necrosis spreads depends on the health of the person with the necrosis. In a healthy person, necrosis can be slow-growing.

However, necrosis may spread more quickly if you have a compromised immune system.

Is it fatal?

If not stopped, necrosis can be fatal. One such example is gangrene. Without treatment, gangrene will continue to progress to healthy tissue.

When should you contact a doctor?  

Contact your doctor if you have any wound or tissue injury that does not heal and becomes progressively worse.

Early diagnosis and treatment are the keys to avoiding a worsened injury. For example, in the case of gangrene, one of the worst necrotic injuries, you should consult your doctor at the first sign of injury.

What causes necrosis?

Necrosis is an abnormal state that results from injury to the cell. The injury can be external or internal. The most common cell injuries include:

  • Hypoxia: This is a lack of oxygen to the cell. Causes include ischemia, shock, and respiratory failure.
  • Physical agents: This is an external injury, such as trauma, or extremes of temperature, such as frostbite, radiation exposure, or electric shock.
  • Chemical agents: This can include poison, occupational exposure, drug toxicity, or recreational drugs. 
  • Biological agents: This includes bacteria, viruses, or fungi.
  • Immunologic reaction: Necrosis may result from an autoimmune response.

What are the different types of necrosis?

There are different types of necrosis, including:

  • Coagulative: This is the default pattern associated with ischemia or hypoxia.
  • Liquefactive: This type is usually associated with infections and injuries in the brain. It usually involves pus.
  • Caseous: This is cell death associated with tuberculosis.
  • Fat necrosis: This is usually associated with inflammation affecting tissues such as breast tissue.
  • Fibrinoid necrosis: This is usually associated with vascular damage such as from viruses.
  • Gangrenous necrosis: This is usually associated with the lower limbs and involves a black, putrid appearance.

What is the treatment for necrosis?

Treatment for necrosis will depend on the cause of the injury. The DIME approach is a foundational approach toward removing and managing wounded tissue.

DIME is a four-step process:

  1. debridement
  2. management of inflammation and infection
  3. moisture control
  4. environmental assessment

DIME is a fundamental process in which your doctor can develop a more detailed plan to treat necrosis based on the type of injury. Possible approaches are:

  • Surgery: This involves surgical removal of the dead tissue, known as debridement. Depending on the severity, this may involve removing patches of skin or completely amputating the limb or organ.
  • Chemical removal: This involves the removal of necrotic tissues. It uses debriding enzymatic agents, such as proteolytic, fibrinolytic, and collagenases. However, researchers do not recommend debriding agents for heavily infected wounds.
  • Maggot therapy: This uses maggot larvae to remove necrotic tissue, and it is a painless process. It is appropriate for large wounds.
  • Physical agents: This involves wounds that physical agents have caused, such as physical trauma or chemical burns. Antibiotics and anti-inflammatory drugs can treat wounds made by physical agents. It involves keeping the wound clean to prevent infection and further necrosis.
  • Chemical and toxic agents: Wounds caused by these agents may require the use of immunosuppressive therapies or anti-inflammatory drugs.  

The body’s natural immune response will remove residual necrotic material left in the body after initial treatment.     

Can you cure necrosis?

There is no cure for necrosis. Treatment will slow down the spreading of necrosis or prevent further injury to surrounding tissues. However, there is no cure for the tissue that is already necrotic.

Can you reverse necrosis?

Necrosis, by definition, is the death of body tissue.

Currently, medical science is not able to reverse necrosis. Reversible tissue injury occurs when the damage is not as severe before it advances to necrosis.

How is necrosis diagnosed?

There are many ways your doctor can diagnose necrosis, or infections leading to necrosis, which may include:

  • physical evaluation
  • blood analysis
  • urine analysis
  • CT scan
  • X-ray
  • MRI scan
  • bone scan
  • white blood cell count
  • swabs of discharge

Summary

Necrosis is irreversible cell death due to injury or trauma. You must remove all dying tissue to prevent further injury to the area.

If you suspect tissue injury that is not healing, the best course of action is to contact your doctor and have it evaluated. Early evaluation and treatment are the keys to preventing further injury.

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Medical Reviewer: Meredith Goodwin, MD, FAAFP
Last Review Date: 2022 May 24
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