Necrosis: Avascular, Breast, and Skin Necrosis Resources
What is Necrosis?
Necrosis has its origins in the Greek word nekros, meaning dead body; it refers to local tissue death in cells. Local tissue death is largely due to a lack of blood supply to the area. Necrosis of any part of the body means there are blood cells or tissues that have died.
Avascular Necrosis
Are Cold Feet and Lower Leg Pain Symptoms of Avascular Necrosis?
Avascular means not associated with or supplied by blood vessels. Avascular necrosis, which is also called osteonecrosis, aseptic necrosis or ischemic necrosis is a bone disease where the cells in a bone become necrotic, or die, due to an interruption of the blood supply, referred to by the word “avascular”, to the tissues of the bone. When enough of the bone components become necrotic, the bone tissue can collapse. When this happens, tiny breaks may form in the bone, leading to larger fractures. The femur, the largest bone in the human body, is particularly susceptible to weakening and collapse due to avascular necrosis. Avascular necrosis is also sometimes called osteonecrosis, ischemic bone necrosis or aseptic necrosis. Joint problems can also arise from avascular necrosis, as when the bones of a joint are necrotized, leading to damage to the joint-bone articular surface. This is called osteochondritis. This can involve one bone, a set of bones or different bones at different times. Eventually, as the disease progresses, the bones die and collapse, causing the patient excessive pain.
The most common manifestation of avascular necrosis occurs in the femur (thigh) bone, although it can also occur in the upper arm, knees, shoulder and ankles. It can easily affect men and women alike and usually occurs between the ages of 30 and 40, although some sources also claim it occurs up to the age of 50.
During the early stages of the disease, there may not be any symptoms, but as the disease progresses, the joint pain becomes more severe. Sufferers may have to take medication, limit their activities, use crutches or undergo surgery.
Causes of Avascular Necrosis
Theorized causes of avascular necrosis can be trauma to the blood vessels, an embolism that obstructs the blood flow, vasculitis (What is vasculitis? It’s an inflammation of the blood vessel walls) and abnormally thick blood. Although research regarding the precise mechanism of what causes avascular necrosis and how it causes the illness is still inconclusive, a variety of causes are believed to lead to the condition in bone tissue. The most common is bone damage due to physical trauma, such as fracture or joint dislocation. Another likely contributing factor is the use of corticosteroids in various medical treatments or illegally as part of a body-building regimen. Heavy alcohol use can also contribute to avascular necrosis, as can hypertension also known as high blood pressure, vascular compression, caisson disease, vasculitis, arterial embolism and thrombosis. Individuals with avascular necrosis can suffer from arthritis, which can lead to avascular necrosis, or suffer from avascular necrosis, which can then lead to arthritis.
Other potential causes include damage from radiation and bisphosphonates, which are believed to particularly affect the mandible, or jaw bone. Sickle cell anemia, Gaucher’s disease and lupus have also been identified with avascular necrosis, as well as rheumatoid arthritis. There are also cases where no widely-observed cause has been found to exist.
What Are the First Signs of Avascular Necrosis?
Joint pains and/or limited mobility around joints are usually the first hints of the illness. Cold feet and lower leg pain are usually not indications of the illness. While pains in the joint or limited mobility can indicate any number of possible illnesses, during the early stages of the disease, an MRI scan or nuclear bone scan can provide a reliable diagnosis of the illness’s progress. Later on, clinicians use X-rays. Already at this point, there is usually advanced damage.
Age, progress of disease and general health factors can help clinicians recommend an effective treatment program. In all cases, physical and occupational therapy can prove to be helpful. Similarly, there are a series of precautions and exercises that one can undertake to prevent or limit the onset of avascular necrosis. When exercising, use pads on knees and elbows to protect joints. Also, low impact exercise, such as bicycling and swimming, puts less pressure on the joints. Moreover, building up muscle strength around the joints deflects pressure on the joints and helps to improve the blood flow to the area.
Who gets Avascular Necrosis More, Men or Women?
Avascular necrosis has a higher incidence in men than women, and mainly affects people over the age of 50. It is a disease that progresses gradually over time, and because there may not be clear symptoms at its onset, a person with avascular necrosis may only realize they have it when they suffer a serious fracture. At that point, a simple x-ray may reveal the presence of the disorder, but in the earlier stages, it can generally be detected only with an MRI or bone scintigraphy. Once diagnosed, management of the disease is a lifelong process.
Treatments Available for Avascular Necrosis
Although nothing can guarantee the prevention of avascular necrosis, several treatments are available. If caught in its early stages, it can be treated with rest, exercise, electrical stimulation and medications such as non-steroidal anti-inflammatory drugs (NSAIDS). At more advanced stages, surgery may be indicated, such as joint replacement, bone transplant, bone reshaping and core decompression.
Surgery as a Treatment
Surgery is also a possibility, albeit more invasive. Early stages of avascular necrosis can be treated by removing the damaged part of the bone and grafting new bone to the damaged area. This enables new blood supply to reach the bone, helping to preserve and repair the area. In later stages of avascular necrosis, joint replacement (anthroplasty) surgery may be required. Recently, nonembryonic stem cell therapy has shown some promising results.
Fentanyl Transdermal Systemas a Treatment for Avascular Necrosis
Pain and/or loss of range of motion are sometimes reported in the parts of the body affected by avascular necrosis, especially the knee, hip, spine, shoulder, ankle, foot, and jaw. One option for treating such pain is the Fentanyl transdermic system. The system consists of a transdermal patch worn on the skin that delivers Fentanyl, a pain medication, through the skin and into the body. Fentanyl is a powerful opioid with a high risk of side effects, so a patient needs to have adjusted to taking some form of opiate-based pain medication, such as morphine, at least every day for a week before starting fentanyl patches. The patch is worn in a non-affected area on the upper part of the torso, which must be kept clean and free of hair or oil. The system is effective for long-term symptomatic treatment of pain caused by avascular necrosis, but it does not treat the disorder itself, and if left untreated the pain could continue to worsen even while wearing the patch.
A patient suffering from avascular necrosis will still need to explore all the various treatment options available for their specific condition, for which the Fentanyl transdermic system offers powerful but ultimately peripheral results.
Resources about Avascular Necrosis
Mayo Clinic information about Avascular necrosis
Medscape.com article about avascular necrosis by Author: Jeanne K Tofferi, MD, MPH, FACP, Assistant Chief, Department of Rheumatology, Walter Reed Army Medical Center, Coauthor(s): William Gilliland, MD, MPHE, FACP, FACR, Staff Rheumatologist, Walter Reed Army Medical Center; Professor of Medicine, Assistant Dean of Curriculum, Uniformed Services University of the Health Sciences
NIAMS Questions and Answers about Osteonecrosis (Avascular Necrosis)
Breast Necrosis
Breast necrosis or breast fat necrosis indicates the death of cell groupings in the breast.
Common Symptoms of Breast Fat Necrosis
Common symptoms of breast fat necrosis include lumps, pain, tenderness in the area, nipple discharge, changes in the nipple size or position, an orange-peel type cover of the skin, dimpling in the skin of the breast and a lump in the armpit that does not go away. Generally, a lump is a knot, bump or swollen area under the skin.
What Can Cause the Death of Cells That Leads to Breast Necrosis or Breast Fat Necrosis?
One possible cause is a trauma to the area, which can damage the nearby cells. This may result in a lump in the breast, commonly an oil cyst that forms instead of scar tissue during healing. This lump will not cause cancer. Similarly, there may be an instance in which fatty breast tissue swells or becomes tender spontaneously. In both these cases, this breast fat necrosis is a benign condition. How are these detected? Generally, breast necrosis can be detected by breast self-examination or during clinical breast examinations. Medical tests such as a mammography or ultrasound/sonogram can usually confirm that the condition is benign. Surgery is usually not recommended; in fact, in the case of oil cysts, aspiration should be sufficient. Occasionally, fat necrosis may mimic a breast cancer clinically, mammographically and sonographically. Therefore, it may be necessary to perform a biopsy to confirm the results.
Breast necrosis can also result from cancer treatments, infections, smoking, excessive cold or heat therapy and extensive use of steroids.
Breast necrosis after breast reconstruction surgery
Breast necrosis can occur after breast reconstruction or breast implantation. In the latter case, dead tissue can collect around the implant and may require surgery or even removal of the implant itself. Necrosis can leave large, permanent scars. >In women undergoing breast reconstruction or implantation, necrosis is more likely to occur in women who smoke. Researchers have found that women who smoked were more likely to experience complications after breast reconstruction, among them breast necrosis. In a 10-year study, conducted at the Cleveland Clinic Foundation in Ohio, researchers compared the outcomes of 155 smokers, 76 former smokers and 517 non-smokers who underwent breast reconstruction following a mastectomy. The results indicated that “complications, including tissue death (necrosis) … were more common in smokers than ex-smokers or non-smokers.” Recommendations are that smokers refrain from smoking at least three weeks prior to breast reconstruction surgery, since scientists believe that smoking decelerates the body’s natural healing process.
Breast necrosis in breast tumors
Finally, breast necrosis can occur in a breast tumor. This usually indicates that the cancer cells in the area are dead, which suggests a fast-growing cancer. This can happen because the tumor’s blood supply is running out. A necrotic breast tumor may be difficult to diagnose with a small biopsy, and an additional sample might need to be taken. Tumor necrosis is often limited to a small area in the region, and since there are usually living cancer cells nearby, the test includes taking samples of them as well.
Resources about Breast Necrosis
Skin and fat necrosis of the breast following methylene blue dye injection for sentinel node biopsy in a patient with breast cancer
Common Breast Lumps What are some common types of benign breast lumps?
Information about Breast Pathology
Skin Necrosis
Causes of Skin Necrosis
Radiation therapy, experiencing a spider bite from a brown recluse spider, or suffering another physical trauma such as a recent operation or severe injury, can cause a serious skin disease called necrosis. If a patient finds that his wound is not healing, but rather is feeling increasingly irritated; if the skin around the wound is starting to look strangely depressed in texture and possibly grey, black, purple or green in color, he may be experiencing a deteriorative skin condition called necrosis. This condition may also occur as a result of exposure to certain medications or chemicals and can typically occur after operations which involve large incisions. Obese people and smokers are at greater risk for this complication, however, it is highly uncommon.
What is Phagocytosis?
When cells die prematurely, they send out chemicals to the surrounding tissue and to the immune system as a whole. These signals activate a process called phagocytosis which is a strange and dangerous cellular reaction. What is phagocytosis? In phagocytosis, the good cells actually engulf the necrotic cells, causing them to become infected. This process starts a cyclical reaction which, if not stopped, can lead to rapid spreading of necrosis.
Treatment of Skin Necrosis
Treatment for skin necrosis involves identifying the root of the problem in order to stop the cellular reaction. There is not a lot of treatment for skin necrosis beyond what is called debridement. This is when necrotic tissue needs to be surgically removed to avoid spreading.
Surgery as a Treatment
Surgery halts this chain reaction through a process called fixation. Fixation is meant to disable biomolecules from releasing enzymes which play a part in this dangerous chain reaction; it strengthens the stability of a cell, or the morphology of the cell. The morphology of a cell refers to the cell shape and structure. This makes it harder for enzymes to effect change in surrounding cells.
What happens if a patient cannot undergo surgery? Perhaps he has another underlying condition which presupposes surgery, such as a weak heart or diabetes. What options exist for him if he has necrosis? Although it would seem that stopping the deadly chain reaction from spreading would be hopeless, hope is not all lost. There is another less conventional treatment that has had good results and in some cases, it might seem that the results are preferable and involve less trauma. This treatment is called maggot larval treatment and it is a form of biosurgery. Believe it or not, the secretions of a certain maggot larvae, have properties which are growth promoting agents. Maggots are released into the wound. They eat at the diseased flesh and lay eggs. The larvae are hatched and secrete cell growth promoting agents. The results of using larvae to heal wounds have been consistently astounding. It seems that the larvae feed on the diseased tissue and their secretions modify the pH of the wound. The result is pink, healthy, rapidly healing skin, where previously diseased skin existed.
Resources about Skin Necrosis
Information and images of skin necrosis
Protein C Deficiency and how it can affect or cause skin necrosis
Article about Warfarin induced skin necrosis.
P. J. Drew, M. J. Smith, and M. A. Milling article about Heparin-induced skin necrosis and low molecular weight heparins.
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