Terminology:
The word necrosis is of Greek origin. Necros means dead.
What is necrosis?
In medicine, necrosis is defined as dead tissue that has developed as a result of cell death due to cell damage. Cell damage can be caused by
- Oxygen deficiency (circulatory disorder due to vascular occlusion): Outflow disorder due to venous occlusion (e.g. renal vein occlusion), inflow disorder due to arterial occlusion (e.g. arteriosclerosis)
- Heat (burns, electric shocks, scalds)
- Chemical burns (acid, alkali)
- Infections (e.g. tuberculosis)
- Tumor damage
Some forms of necrosis in plastic surgery:
Fatty tissue necrosis
Adipose tissue necrosis can occur in all operations in which larger wound surfaces occur in the area of the adipose tissue. Incised fat cells perish or some of these cells are undersupplied with oxygen, e.g. due to tension, and die. Fat tissue necrosis can occur in particular during breast reduction, breast lift, tummy tuck and generally during all major tightening operations.
Skin necrosis
Postoperative skin necrosis is usually the result of increased tension and/or a lack of immobilization, particularly at the corner sutures (‘saddle corners’) in T-thigh lifts, T-breast lifts, upper arm lifts or in the middle suture area of tummy tucks.
Skin necrosis can also occur during sweat gland removal by lipocurettage. Smaller and larger defects can occur, particularly with delicate skin and more aggressive procedures (curettage). However, these have an impressive tendency to shrink.
Burn necrosis
The degree classification of the burn/scald describes the severity of the tissue damage:
- Grade I : Injury to the top layer of skin (epidermis) -> Healing without scars
- Grade IIa: Injury to a superficial part of the dermis -> only minor scarring
- Grade IIb: deeper than grade IIa, deep dermis is injured -> Healing with scarring
- Grade III: Necrosis of the entire skin layer -> Healing with severe scarring
- Grade IV: deeper structures are also injured; necrosis of muscles, tendons, bones …
