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NECROTOMY (grech, nekros dead, tome a section, a section) — the operative measure consisting in a section of devitalized fabrics.

N. is shown most often at freezing injuries and burns of III and IV degrees when it provides outflow of liquid from devitalized fabrics.

As showed researches of school S. S. Girgolava, N. at freezing injuries is one of the few methods of transfer of wet gangrene in dry. At the same time process of mummification accelerates, borders of necrosis come to light quicker, intensity and prevalence of inflammatory changes in surrounding fabrics decrease. As a result of N. together with wound liquid from a zone of disintegration of fabrics also toxicants are removed at the expense of what intoxication of an organism considerably decreases. For prevention of the ischemic and respiratory frustration caused by a prelum of fabrics and disturbance in them krovo-and lymphokineses at deep burns of extremities, the trunks covering their circle the so-called circular necrotomy is applied.

The N quite often is the first stage of surgical treatment of an affected area allowing to prepare during 1 — 3 week fabrics for the second stage — necretomies (see) or, at indications, to early amputation within healthy fabrics that promotes reduction of terms of treatment. N, as a rule, do not make on fingers of top and bottom extremities at the isolated their defeat since because of a small amount of soft tissues wet gangrene develops seldom here.

Foot of the patient after the necrotomy made concerning freezing injury of the IV degree: devitalized fabrics are cut by slits.

Operation is made on 5 — the 6th day after freezing injury (at burns sometimes in the first days) when borders of necrosis come to light. Anesthesia, as a rule, is not required as in a zone of a necrosis there is no painful and tactile sensitivity. The site of a necrosis is processed alcohol. Otstupya on 0,5 — 1,0 cm distally from the line of demarcation, carry out several slits (fig.), cutting nekrotizirovanny fabrics on all their depth. Emergence of dot bleedings and the minimum pain will demonstrate that the scalpel went beyond a zone of a necrosis. After N. on 1 — 2 day apply spirit bandages the field of operation.

The N at necrosis of a bone carries the name of a sequestrotomy. Refer opening of the centers of curdled disintegration in lungs to N operations (see. Cavernotomy ), tubercular abscesses (see. Natechnik ).

Yu. V. Struchkov.