Removal of papillomas with liquid nitrogen
The content of the article:
- What is cryodestruction?
- How does liquid nitrogen work on fabrics?
- How is cryodestruction performed?
- Indications
- Contraindications
- Benefits
- disadvantages
- Complications
- Postoperative management
- What are papillomas
- Causes of occurrence
- Video
Removal of papillomas with liquid nitrogen allows you to quickly rid a person of epidermal growths on the skin and mucous membranes. This method of surgical treatment has been used in dermatology for over 40 years.
Cryodestruction is one of the most popular and effective methods for removing papillomas
What is cryodestruction?
Cryodestruction is an effective minimally invasive surgical technique for removing benign and some malignant neoplasms of the skin and mucous membranes. Its essence lies in the very rapid freezing of pathologically altered tissue with liquid nitrogen (boiling point -196 ° C), followed by its slow thawing.
How does liquid nitrogen work on fabrics?
The following factors lead to destruction (irreversible damage) of tissue under the influence of ultra-low temperatures:
- Dehydration. During the freezing process, the water turns into ice crystals. This is accompanied by a significant increase in the concentration of electrolytes, both in the intracellular and in the extracellular space.
- Mechanical damage to membranes. At temperatures below -4 ° C, ice begins to expand, thereby causing damage to cell membranes.
- Chemical damage to cells. Under the influence of low temperatures, denaturation of phospholipids and proteins occurs, a number of enzyme systems are activated, which causes the destruction of cellular structures.
- Terminal shock. The cessation of the movement of protoplasm becomes the cause of the launch of irreversible destructive processes in cells.
- Ischemia. In tissue exposed to low temperatures, blood supply is disrupted. This leads to a focus of ischemic necrosis.
Cryodestruction is characterized by the presence of three successive phases:
| Phase name | Main characteristics |
| Cryophobia | There is a change in the natural color of the tissue, its edema develops, and the nature of innervation changes. Clinically, this is manifested by paleness and thickening of the skin, a decrease in its sensitivity. At this point, the patient may experience discomfort, a slight burning sensation, and tingling. Then, hyperemia and collateral edema develop in the affected area, which persist for 1-3 hours |
| Cryonecrosis | It is characterized by total thrombosis of blood vessels, which is the cause of increasing tissue ischemia with further formation of a necrosis focus in it. After the procedure of cauterization with liquid nitrogen, an epidermal bladder is formed at the site of exposure, filled with necrotic fluid. In the future, it is opened and replaced with a black crust. |
| Repair | At this stage, there is a gradual restoration of the damaged epithelial cell layer. Complete rejection of necrotic masses ends in 2-4 weeks. After that, a small pink spot remains in the area of papilloma cauterization with liquid nitrogen. Subsequently, complete organotypic tissue regeneration occurs. This process takes approximately 6 months. |
How is cryodestruction performed?
Cryodestruction of skin growths is performed on an outpatient basis, that is, immediately after the completion of the procedure, the patient can leave the clinic. Local infiltration anesthesia is performed to eliminate discomfort and pain.
There are two ways to perform cryodestruction:
- Contact. It is characterized by direct contact of the neoplasm tissue with a cryoprobe tip of the appropriate size and shape cooled with liquid nitrogen. This method provides the most effective and accurate effect on the problem area of the skin or mucous membrane.
- Contactless. A vapor-liquid stream of nitrogen, formed with the help of a special cryo-atomizer, is directed to the neoplasm.
The choice of a method for removing papillomas with liquid nitrogen is carried out by the attending physician, taking into account the peculiarities of the localization of growths, their size, type of structure.
Indications
The main indications for cryodestruction are:
- removal of benign skin formations (keratomas, papillomas, pigmented nevus);
- removal of hypertrophic or keloid scars.
Contraindications
Contraindications for the removal of papillomas with liquid nitrogen include:
- diabetes mellitus in the stage of decompensation;
- impaired blood clotting;
- pregnancy and lactation;
- systemic connective tissue diseases;
- a history of allergic reactions to cold, such as cold urticaria;
- an indication of a history of cancer;
- diseases of the blood vessels, accompanied by their spasm;
- cold hemolytic anemia (destruction of erythrophytes under the influence of exposure to cold);
- pronounced skin pigmentation in the area of cryosurgical treatment.
Benefits
Removing skin lesions with liquid nitrogen has a number of advantages:
- Minimal impact on healthy tissues surrounding the neoplasm, as a result of which they are practically not damaged.
- The procedure is practically painless, as under the influence of ultra-low temperature, the sensitive nerve endings of the skin in the area of intervention are destroyed very quickly.
- The spasm of small blood vessels and their total thrombosis, which develops almost instantly in the affected area, make the procedure bloodless.
- High resistance of the walls of medium and large blood vessels to low temperatures, which allows cryodestruction of skin formations located in the immediate vicinity of large vessels.
- Ability to control the degree of tissue destruction.
- Organotypic complete restoration of tissue in the affected area.
- Low risk of gross scarring and complications.
disadvantages
Like any other treatment method, cryodestruction has not only advantages, but also disadvantages. These include:
- Long term regeneration of damaged tissues (up to 20-25 days).
- Inability to take tissue for subsequent histological analysis.
- Inappropriateness of the procedure to remove large neoplasms.
Complications
Since the method of cryodestruction is accompanied by a violation of the integrity of the tissue, then its use may be accompanied, although very rarely, by the development of the following complications:
- accession of a secondary infection with the development of purulent-inflammatory processes (abscess, phlegmon);
- increased skin pigmentation;
- the occurrence of bleeding.
Postoperative management
The wound heals for a long time after the intervention. It must be carefully cared for, which prevents the occurrence of negative consequences.
Every day, the wound is washed with an antiseptic solution (Chlorhexidine, hydrogen peroxide) and ointments are applied to it, which include antibacterial and wound-healing components (panthenol, chloramphenicol). For the prevention of infectious complications, powders with antibiotics (Baneocin, Gentaksan) can be used.
After the treatment, a bandage is applied, since when direct sunlight hits the wound, the healing process is disrupted and the risk of hyperpigmentation increases.
Cryodestruction is performed on an outpatient basis, immediately after the procedure, the patient can go home
What are papillomas
Papillomas (warts) are benign growths on the skin or mucous membranes. They look like a small spherical growth on a thick base or stem and have a soft consistency. Usually the size of warts does not exceed 1-2 cm. The surface is uneven. The color can range from flesh to dirty brown.
Papillomas can be both single and multiple. Several nearby formations can merge with each other, as a result, their surface takes on a bizarre shape, reminiscent of a cauliflower inflorescence or cockscomb.
In the presence of multiple papillomas, the disease is called papillomatosis.
Causes of occurrence
The cause of papillomas is infection of the human body with the human papillomavirus (HPV). The source of infection is sick people or virus carriers. Infection is also possible through close contact with animals.
The virus enters the body through damage to the skin or mucous membranes. For a long time, it is in the cells of the epithelium, not manifesting itself. With a decrease in immunity, HPV begins to actively multiply, integrate into the genome of cells, leading to an acceleration of the processes of mitosis and cell growth, as a result of which the formation of wart growths occurs.
To suppress the activity of the virus and reduce the risk of the likelihood of relapse, after removal of papillomas, doctors must recommend to patients one or more courses of taking antiviral and immunomodulatory drugs.
Video
We offer for viewing a video on the topic of the article.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
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