What are the first signs of impending necrosis?

Author: Dr. Brendan Gaylord  |  Last update: Sunday, January 4, 2026

Cells that are undergoing necrosis swell and then burst (cytolysis), releasing their contents into the surrounding area. This results in a locally triggered inflammatory reaction characterized by swelling, pain, heat, and redness.

What does the start of necrosis feel like?

There may be no symptoms of osteonecrosis at first, but as the disease progresses, you may gradually start to feel pain, especially in weight-bearing bones such as the thigh bone (femur). The disease most commonly affects the hip joint, and the pain is usually felt in the groin or, less commonly, in the buttock area.

How quickly does necrosis occur after fillers?

The symptoms of ischemia can occur immediately after the injection or several hours after the procedure. Here, the authors report three cases of necrosis after hyaluronic acid injection with the first symptoms presenting only several hours after the procedure.

How do you fix necrosis?

In many cases, necrosis treatment starts by identifying and addressing the cause of cell death. Restoring blood flow to the affected areas is the most important priority to prevent further damage. Once the blood supply has been restored, which may require surgery, any dead tissue can be removed.

What does early stage necrosis look like?

The skin may look pale at first but quickly becomes red or bronze and warm to the touch and swollen. Pain is intense. Later, the skin turns violet, often with the development of large fluid-filled blisters (bullae). The fluid from these blisters is brown, watery, and sometimes foul smelling.

Face the Case: Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection

What is the hallmark of necrosis?

The loss of structural integrity of the plasma membrane is a hallmark of necrosis and represents the common final endpoint at which a cell can no longer maintain its discrete identity from the environment.

What triggers necrosis?

Necrosis is the medical term for the death of your body tissue. When the cells in your tissues die, it can affect many different areas of your body, including your bones, skin and organs. Necrosis can occur because of illness, infection, injury, disease or lack of blood flow to your tissues.

What is the best ointment for necrotic tissue?

SANTYL Ointment is an enzymatic debrider that actively and selectively removes necrotic/dead tissue from a wound without harming healthy tissue. Removing the barrier of necrotic tissue helps stalled and/or chronic wounds move toward closure.

What are the symptoms of a deep tissue infection?

They generally start with mild symptoms like redness, warmth, swelling, or discharge at the infection site. More serious symptoms can include fever, chills, change in mental status, nausea, skin dimpling, or vomiting.

What does necrosis look like after fillers?

We'll be brutally honest here: the appearance of necrosis after filler is not for the faint of heart. In this case, necrosis often turns the skin blue or gives it a blue cast. It can also result in pustules and a scaly look along with white plaques. Sometimes the affected skin turns black.

How does necrosis start out?

Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated digestion of cell components. In contrast, apoptosis is a naturally occurring programmed and targeted cause of cellular death.

How do you know if your body is rejecting filler?

If you experience any signs of an allergic reaction after a filler injection, such as tenderness, swelling or asymmetrical fullness, seek medical attention immediately. Ask your doctor to test for allergies to the injectable fillers and/or the liquid gel in which they are suspended.

What is the final stage of necrosis?

Late Collapse Stage: The late collapse stage is the most advanced stage of avascular necrosis, where the bone has completely collapsed, and the joint is severely damaged. Symptoms during this stage may include severe pain, limited range of motion, and difficulty walking or standing.

What does necrosis smell like?

Odor: The smell is malodorous with typically a purulent-type odor. Consistency: The tissue is often flimsy and without the ability to granulate or bleed.

What happens if necrotic tissue is not removed?

A necrotizing soft tissue infection can destroy skin, muscle, and other soft tissues. If untreated, it may lead to amputation of major parts of the body, kidney failure and a high risk of death.

What clears necrotic tissue?

Debridement:

Surgical debridement or enzymatic debridement using specialized dressings may be necessary to remove necrotic tissue and promote wound healing. Other options include autolytic, mechanical, enzymatic, and biologic debridement.

What ointment removes slough?

Collagenase SANTYL® Ointment utilizes this enzyme in a petrolatum ointment base to loosen slough from the wound bed which can then be removed by successive cleansing and dressing changes.

What antibiotic is used for necrosis?

Antimicrobial therapy for necrotizing fasciitis is as follows: Imipenem 1 g every 6 to 8 hours, daptomycin 6 mg/kg QD, and clindamycin 600 mg to 900 mg 4 times daily. Piperacillin/tazobactam 3.375 g every 6 hours or 4.5 g every 8 hours, daptomycin 6 mg/kg QD, and clindamycin 600 mg to 900 mg 4 times daily.

How do you tell if you have necrosis?

Symptoms
  • A small, red, painful lump or bump on the skin that spreads.
  • A very painful bruise-like area then develops and grows rapidly, sometimes in less than an hour.
  • The center becomes dark and dusky and then turns black and the tissue dies.
  • The skin may break open and ooze fluid.

What heals necrosis?

Debridement techniques, such as sharp debridement, enzymatic debridement, autolytic debridement, or surgical debridement, are used to remove necrotic tissue and facilitate the formation of healthy granulation tissue.

How fast does necrosis spread?

This wound will grow in size as the bacteria multiply and spread. The bacteria reproduce at a rapid rate, so the area of infected tissue will expand incredibly quickly. It is different in every case, but it is possible that a patient will have a large open wound within 48 hours of the onset of symptoms.

What color is necrosis?

There are two main types of necrotic tissue present in wounds. One is a dry, thick, leathery tissue usually a tan, brown, or black color. The other is often yellow, tan, green, or brown and might be moist, loose, and stringy in appearance. Necrotic tissue will eventually become black, hard, and leathery.

What is impending necrosis of the skin?

Impending necrosis following soft tissue filler injection is a major, early-onset complication that is likely the result of vascular injury, compression or obstruction of the facial artery, angular artery, lateral nasal artery, supratrochlear artery or their branches and requires swift and aggressive treatment in order ...

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