From Big Medical Encyclopedia

NECRETOMY (Greek nekros dead + ektome excision, removal) — the operative measure consisting at a distance devitalized fabrics.

For the first time at limited burns of the III degree reported M. V about N. ilm since (1901). The N at a burn with the subsequent skin transplantation was offered by Willis (M. of Willis, 1925). In 1914 J. Erdheim made N. at a peculiar necrosis of hypodermic cellulose as a result of a prick an ink pencil. N.'s technique at freezing injuries is developed by school S. S. Girgolava in the mid-thirties 20 century V. P. Humpbacks (1933), M. T. Friedman and L. I. Troshina (1935, 1938) experimentally proved that at early (in 1,5 — 6 hours) excision of the site of skin, nekrotizirovanny owing to a burn, with imposing of primary seam it is possible to receive primary healing on 7 — the 8th days.

Indication to N. availability of devitalized fabrics in the struck area is that can take place at various diseases, most often at deep freezing injuries (see) and burns (see). The nature of operation, her technician and volume are defined depending on specific conditions.

Foot after the necretomy made concerning freezing injury of the IV degree: devitalized distal phalanxes of fingers are isolated, plusnevy bones are partially naked; 1 — granultsionny fabric, 2 — the unimpaired fabrics.

At N.'s freezing injuries it is reasonable to make in 4 — 7 days after an injury when a clear boundary of a necrosis comes to light. In some cases for 1 — 3 week before N. as preparation for it it is necessary to make necrotomy (see). In these cases of N. is the second stage of operational treatment. Quite often the necrotomy is combined with N., and sometimes the surgeon, having begun a necrotomy, can finish an operative measure with a necretomy. At freezing injuries delete all devitalized fabrics, except for the narrow strip of 0,5 — 1,0 cm which is directly adjoining a line of demarcation. At the same time danger of an infection is minimized thanks to the left strip, edges are formed by the scab which is densely covering granulations. At N. exarticulations in joints (fig.) since at a perepilivaniye or a perekusyvaniye of bones marrowy cavities are opened that is fraught with hit of an infection and its distribution up a bone are preferable.

At burns of the IV degree of N. it is carried out by the same principles, as at freezing injuries. At burns of IIIB devitalized sites excise degrees no more than 8 — 10% of a body surface in the first 7 — 8 days after an injury within healthy fabrics both on a surface, and in depth. Operation is made under anesthetic. On the formed wound put primary stitches, and at big defect of fabrics close it by skin transplantation (see. Skin plastics ).

The N is applied at necrosis of a bone tissue (see. Sekvkstrektomiya ), purulent damage of joints (intra joint N.), at a tuberculosis of bones and joints when delete not only the main center, napr, in a body or a handle of a vertebra, but also exsect a natechnik and together with the capsule (see. Natechnik ),

In modern conditions of N operation gain ground. Treat them, e.g., early (to a stage of purulent fusion) excision of the necrotic center at felons (see), excision of a suppurative focus with imposing of a deaf seam and the subsequent washing by antibacterial solutions at mastitis (see), etc.

See also Gangrene , Necrosis .

Yu. V. Struchkov.