Necrosis - Treatment

Treatment

There are many causes of necrosis, and as such treatment is based upon on how the necrosis came about. Treatment of necrosis typically involves two distinct processes. Usually, the underlying cause of the necrosis must be treated before the dead tissue itself can be dealt with.

• In the case of ischemia, which includes myocardial infarction, the restriction of blood supply to tissues causes hypoxia and the creation of reactive oxygen species (ROS) that react with, and damage proteins and membranes. Antioxidant treatments can be applied to scavenge the ROS.

• Wounds caused by physical agents, including direct physical trauma and injury, can be treated with antibiotics and anti-inflammatory drugs to prevent bacterial infection and inflammation. Keeping the wound clean from infection also prevents necrosis.

• Chemical and toxic agents (e.g. pharmaceutical drugs, acids, bases) react with the skin leading to skin loss and eventually necrosis. Treatment involves identification and discontinuation of the harmful agent, followed by treatment of the wound, including prevention of infection and possibly the use of immunosuppressive therapies such as anti-inflammatory drugs or immunosuppressants. In the example of a snake bite, the use of anti-venom halts the spread of toxins whilst receiving antibiotics to impede infection.

Even after the initial cause of the necrosis has been halted, the necrotic tissue will remain in the body. The body's immune response to apoptosis, which involves the automatic breaking down and recycling of cellular material, is not triggered by necrotic cell death due to the apoptotic pathway being disabled. The standard therapy for necrosis is removal of the dead tissue (debridement) eiher by surgical or non-surgical means. Depending on the severity of the necrosis, this may range from removal of small patches of skin, to complete amputation of affected limbs or organs. Chemical removal of necrotic tissue is another option in which enzymatic debriding agents, categorised as proteolytic, fibrinolytic or collangenases, are used to target the various components of dead tissue. In select cases, special maggot therapy using Lucilia sericata larvae has been employed to remove necrotic tissue and infection.