# Fat Necrosis



## Pookie (Feb 21, 2008)

I had a bad fall at work a couple of weeks ago, the kitchen floor is made of old tiles, that when wet, are incredibly slippery. There have been several times before that I have nearly slipped over, as have others.

But that day the floor was still wet from being mopped after lunch time, several hours because it doesnt dry. I was going to the sink and my foot slipped under the shelf under the sink, so to not break my leg I grabbed out with my hand and ended up slamming into the corner of the metal sink.

I have really badly wrenched my shoulder, sprained my ankle and a minor sprain to my wrist. But the worst was where my tummy hit the corner of the sink. I have a huge deep nasty bruise. Its most of one side of my tummy.

The bruise was about 15cm long by 12cm wide. Its mostly healed but I could feel a lump in the bit that was the centre of the bruise, where the corner went the deepest.

So, I went to the Dr's yesterday well.... I can now say in all honesty I am technically, officially, partially dead. Thats right... I have a lump of necrosis. Because fat has a relatively poor blood supply, the injury, the deep bruising and swelling led to a section being not supplied so it died.

I am officially dead inside 

Fat Necrosis

Doesn't it sound just amazing? Now I watch it, poke it and hopefully my body has the skills to break it down and absorb it. If it doesnt, or it gets more painful or bigger then it can be surgically sucked out, or possibly cut out, but I KNOW my stomach already has very poor wound healing capabilities because even cat scratches take forever, so I really hope it doesn't get that far.

Forgive the grim humour, its somewhat amusing to me to be saying something is dead inside and actually mean it. It is endlessly amusing right now... the Dr finally agreeing the clincally depressed are dead inside 

I wondered if anybody else has dealt with this? Is there anything I can do to try help my body deal with it so I dont have to have any medical intervention?


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## D_A_Bunny (Feb 21, 2008)

Ouch, that sucks. I hope that it doesn't hurt too bad, but I guess with all of the other injuries that may hurt the least right now. 
While I cannot speak specifically to this problem, last year I had surgery where they removed a large section of my labia because of infection. I am diabetic and was in very poor health. Hence the need for the surgery. While in medical care, they totally upped my protein intake which aids healing immensely. Also, magnesium, which I believe you can find in Tums.
You would be surprised how much protein you actually need to heal. This certainly would help with your other injuries as well. Sometimes, you can find a yummy protein supplement drink that is really healthy with extra vitamins too.
I wish you good luck with this.


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## LalaCity (Feb 22, 2008)

oy -- that's unpleasant...The fact that part of your wound has necrotized would give you heebie jeebies, to be sure...but the body is always producing dead cells (hair, fingernails, etc.) so don't get too freaked out -- hopefully it will all be re-absorbed.


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## moore2me (Feb 23, 2008)

Dear Pookie,

First off, since this happened at work, I hope you listed this as a workplace accident. Your medical treatment should be covered under worker's comp and if you need more treatment or time off, it should be covered as well. If you have not filed an accident report, you should do it now - retroactively.

Secondly, the company should do something about that slippery floor. There are treatments for slippery floor tiles such as covering them with a mat, treating with special anti-slipping paint, or giving the workers shoes that are designed for walking & gripping on wet floors. I wear Keen shoes designed for water sports and they hold their grip on wet concrete. You can order them on the internet. They have saved my butt from slipping several times.

As to medical treatment for your injury, I did a computer search under Medline and found a few articles that talked about wound treatment for adipose (fat) tissue necrosis. The articles are copied below. You could print this and give them to your doctor. I noticed that they recommended decompression chamber treatment, immunonutrition, inflammation response controls (immunoglobulin), among other things. Some of the info is kind of techie, but that's they way they write these medical journals. Some of it may not apply to your situation, but I just used a "shotgun" approach.
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Journal: *Injury*. 2007 Dec;38(12):1336-45. 
*Systemic inflammation after trauma.*
Lenz A, Franklin GA, Cheadle WG.
Veterans Affairs Medical Center, Louisville, USA.

Trauma is still one of the main reasons for death among the population worldwide. Mortality occurring early after injury is due to "first hits", including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). "Second hits" such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma. SIRS can lead to tissue destruction in organs not originally affected by the initial trauma with subsequent development of multi-organ dysfunction (MOD). The initial pro-inflammatory response is followed by an anti-inflammatory response and can result in immune suppression with high risk of infection and sepsis. Trauma causes activation of nearly all components of the immune system. It activates the neuroendocrine system and local tissue destruction and accumulation of toxic byproducts of metabolic respiration leads to release of mediators. Extensive tissue injury may result in spillover of these mediators into the peripheral bloodstream to further maintain and augment the pro-inflammatory response. Hormones like ACTH, corticosteroids and catecholamines as well as cytokines, chemokines and alarmins play important roles in the initiation and persistence of the pro-inflammatory response after severe injury. The purpose of this review is therefore to describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response.
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Journal: *J Endotoxin Res*. 2006;12(3):151-70. 
*Compartmentalization of the inflammatory response in sepsis and SIRS.*
Cavaillon JM, Annane D.
Cytokines & Inflammation, Institut Pasteur, Paris, France. [email protected]

Sepsis and systemic inflammatory response syndrome (SIRS) are associated with an exacerbated production of both pro- and anti-inflammatory mediators that are mainly produced within tissues. Although a systemic process, the pathophysiological events differ from organ to organ, and from organ to peripheral blood, leading to the concept of compartmentalization. The nature of the insult (e.g. burn, hemorrhage, trauma, peritonitis), the cellular composition of each compartment (e.g. nature of phagocytes, nature of endothelial cells), and its micro-environment (e.g. local presence of granulocyte-macrophage colony stimulating factor [GM-CSF] in the lungs, low levels of arginine in the liver, release of endotoxin from the gut), and leukocyte recruitment, have a great influence on local inflammation and on tissue injury. High levels of pro-inflammatory mediators (e.g. interleukin-1 [IL-1], tumor necrosis factor [TNF], gamma interferon [IFN-gamma], high mobility group protein-1 [HMGB1], macrophage migration inhibitory factor [MIF]) produced locally and released into the blood stream initiate remote organ injury as a consequence of an organ cross-talk. The inflammatory response within the tissues is greatly influenced by the local delivery of neuromediators by the cholinergic and sympathetic neurons. Acetylcholine and epinephrine contribute with IL-10 and other mediators to the anti-inflammatory compensatory response initiated to dampen the inflammatory process. Unfortunately, this regulatory response leads to an altered immune status of leukocytes that can increase the susceptibility to further infection. Again, the nature of the insult, the nature of the leukocytes, the presence of circulating microbial components, and the nature of the triggering agent employed to trigger cells, greatly influence the immune status of the leukocytes that may differ from one compartment to another. While anti-inflammatory mediators predominate within the blood stream to avoid igniting new inflammatory foci, their presence within tissues may not always be sufficient to prevent the initiation of a deleterious inflammatory response in the different compartments.
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Journal: *Injury*. 2007 Dec;38(12):1409-22. 
*Role of biological modifiers regulating the immune response after trauma.*
Stahel PF, Smith WR, Moore EE.
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.

Trauma induces a profound immunological dysfunction. This is characterised by an early state of hyperinflammation, followed by a phase of immunosuppression with increased susceptibility to infection and multiple organ failure. Therapeutic strategies directed at restoring immune homeostasis after traumatic injuries have largely failed in translation from "bench to bedside". The present review illustrates the role of biological modifiers of the posttraumatic immune response by portraying different modalities of therapeutic immune modulation. The emphasis is placed on anti-inflammatory (steroids) and immune-stimulatory (interferon) pharmacological strategies and modified resuscitative strategies, as well as more unconventional immunomodulatory approaches, such as immunonutrition.
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*Journal of Long Term Eff Med Implants*. 2005;15(1):57-65. 
*Massive soft tissue infections: necrotizing fasciitis and purpura fulminans*.
Edlich RF, Winters KL, Woodard CR, Britt LD, Long WB 3rd.
University of Virginia Health System, Charlottesville, Virginia, USA. [email protected]

Necrotizing fasciitis and purpura fulminans are two destructive infections that involve both skin and soft tissue. Necrotizing fasciitis is characterized by widespread necrosis of subcutaneous tissue and the fascia. Historically, group A beta-hemolytic streptococcus has been identified as a major cause of this infection. However, this monomicrobial infection is usually associated with some underlying cause, such as diabetes mellitus. During the last two decades, scientists have found that the pathogenesis of necrotizing fasciitis is polymicrobial. The diagnosis of necrotizing fasciitis must be made as soon as possible by examining the skin inflammatory changes. Magnetic resonance imaging is strongly recommended to detect the presence of air within the tissues. Percutaneous aspiration of the soft tissue infection followed by prompt Gram staining should be conducted with the "finger-test" and rapid-frozen section biopsy examination. Intravenous antibiotic therapy is one of the cornerstones of managing this life-threatening skin infection. Surgery is the primary treatment for necrotizing fasciitis, with early surgical fasciotomy and debridement. Following debridement, skin coverage by either Integra Dermal Regeneration Template or AlloDerm should be undertaken. Hyperbaric oxygen therapy complemented by intravenous polyspecific immunoglobulin are useful adjunctive therapies. Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin; it is rapidly progressive and accompanied by vascular collapse. There are three types of purpura fulminans: neonatal purpura fulminans, idiopathic or chronic purpura fulminans, and acute infectious purpura fulminans. Clinical presentation of purpura fulminans involves a premonitory illness followed by the rapid development of a septic syndrome with fever, shock, and disseminated intravascular coagulation. The diagnosis and treatment of these conditions is best accomplished in a regional burn center in which management of multiple organ failure can be conducted with aggressive debridement and fasciotomy of the necrotic skin. The newest revolutionary advancement in the treatment of neonatal purpura fulminans is the use of activated protein C.
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Journal: *Surg Gynecol Obstet*. 1979 May;148(5):785-9.Fat necrosis.Lee PC, Howard JM.

Fat necrosis has been found to be associated with many forms of pancreatitis, carcinoma of the pancreas and pancreatic trauma. The causative agents seem to be pancreatic lipase and colipase, which presumably escape from the pancreas during the development of the disease. The precise mechanism by which these factors attack the adipose tissue, leading to the formation of foci of fat necrosis, is not known. The pathologic finding of fat necrosis is not restricted to the peritoneal-retroperitoneal region, where a direct contact with these factors is the most likely cause. In other patients, fat necrosis involves peripheral tissues, notably in subcutaneous adipose tissue throughout the body, in joints of the hand and foot and in bone marrow. This is associated with additional complications dependent upon the sites involved and is manifested as skin lesions, polyarthritis and osteolytic defects in patients who sometime suffer from a primary pancreatic disease.


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## David Bowie (Feb 24, 2008)

all i have to say is "that'sGnarly."


but yeah that's a drag


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## altered states (Feb 24, 2008)

moore2me said:


> First off, since this happened at work, I hope you listed this as a workplace accident. Your medical treatment should be covered under worker's comp and if you need more treatment or time off, it should be covered as well. If you have not filed an accident report, you should do it now - retroactively.



That's what I was thinking, but then she's in the UK so worker's comp isn't necessary because they have a modern, humanistic, civilized society. That said, too bad she's not in the US, because a fall like that at work under the circumstances she describes would have had me thinking "ka-ching."


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## moore2me (Feb 24, 2008)

tres huevos said:


> That's what I was thinking, but then she's in the UK so worker's comp isn't necessary because they have a modern, humanistic, civilized society. That said, too bad she's not in the US, because a fall like that at work under the circumstances she describes would have had me thinking "ka-ching."



Dear Tres huevos, I worked for over 20 years for state government and had a lot of dealing with our workers compensation system. Believe me, most injured workers are in NO way thinking "ka-ching". Getting hurt on the job is bad enough, but when you find out what you are entitled to, it's not worth ruining your body for such small monetary sums. For example,

Workers Comp in Ark pays the following to the injured person:
- First seven days, you get nothing.

- Second week, you start making about 85% of your weekly wage up to a max of $189. And, many employers now have a return to work program where injured employees are brought back to the job and work on light duty during their convalescent period. It is unusual to find an injured employee that stays at home for several weeks at a time.

And if youre interested in a permanent disability, here are the payments to workers that are injured on the job based on the body part that was injured. Now I ask you, would you have your hand amputated (without anesthesia) for $37,720? How about having both testicles cut off (still no anesthesia) for the princely sum of $32,390? Still thinking ka-ching?

Here are some examples of injury compensations:
- Arm amputated at the elbow . . . . you get. . . . . $50,020
- Leg amputated at the knee . . . . . you get. . . . . $37,720
- Hand amputated . . . . . . . . . . . . . you get. . . . .$37,515 
- First finger amputated. . . . . . . . . .you get . . . . . $8,815
- Permanent loss of a good eye from the socket . . . $21,525
- Loss of one testicle . . . . . . . . . . . you get. . . . .$10,865
- Loss of two testicles . . . . . . . . . . you get . . . . $32,390 

To make matters worse, a severely injured worker can undergo psychological as well as physical damage. He or she can lose their livelihood; start having family troubles, financial trouble, and start spiraling downwards. If you are unlucky enough to hurt your back at work, tough. State law specifically says that pain shall not be used as a basis for physical impairment. Most back injuries do not show physical evidence, except the patients complaint of pain.


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## Miss Vickie (Feb 24, 2008)

The problem though, is that Pookie's in the UK so I'm not sure what they have in terms of Worker's Compensation, particularly given that they have NHS. Interesting question, though.

Pookie, I hope you're feeling better and this thing heals up nice and quick! And tell those bosses of yours to make your work place safer. YIKES! Ya could have split your head open!


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## moore2me (Feb 25, 2008)

Miss Vickie said:


> The problem though, is that Pookie's in the UK so I'm not sure what they have in terms of Worker's Compensation, particularly given that they have NHS. Interesting question, though.
> 
> Pookie, I hope you're feeling better and this thing heals up nice and quick! And tell those bosses of yours to make your work place safer. YIKES! Ya could have split your head open!



Dear Miss Vickie, Tres Huevos already pointed out to me that Pookie was in England and that Worker's Comp there is different. I was just responding to his statement that if she was in America that she would be making money from the injury - something I disagree with. 

I too hope Pookie gets better soon. It sounds like that kind of injury is no fun at all and nothing to take lightly. Hopefully, if you're young & healthy your body can reabsorb the damaged tissue. 

Now as to the employer fixing the slippery floor, I found some recommendations for controlling slips and falls in the restaurant & food business. They are from CNA and I have copied them below. Pookie should give her employer this list.

From www.nfsi.org/images/pdfs/slipandfall062007.pdf
Document written by CNA Risk Control website www.cna.com/riskcontrol.


*Slips and Falls Study:
Objective Auditing Techniques to Control Slips and Falls in Restaurants​*June 2007

RECOMMENDATIONS
Based on our study and findings, we made these general recommendations to the restaurant chain. These recommendations can be applied to most restaurants to help lower their risks for slip-and-fall incidents.

 Select high-traction, slip-resistant flooring materials when you build, expand or remodel facilities. Installation of such materials with proven high traction characteristics is one of the best ways to avoid slip-and-fall issues.

 Know what the out-of-the-box slip resistance is on the floor materials in your facility. These numbers provide a baseline when considering changes to cleaning and floor maintenance practices. Have flooring COF audited after installation to confirm slip resistance.

 Select floor cleaning and maintenance products with proven slip resistance
characteristics that are compatible with the particular flooring surfaces in your facility. A good place to start are materials certified by the National Floor Safety Institute (www.nfsi.org).

 Be alert for workers substituting cleaning materials or supplies. Ensure sufficient supplies cleaning of supplies are available.

 Apply floor cleaning and maintenance products in accordance with the
manufacturers recommendations.

 Verify with the cleaning personnel that they are familiar with and are using the correct application procedures. If there is a change in personnel or contractor, monitor usage again.

 Remove any unauthorized or incompatible cleaning products and educate staff of the potentially dangerous consequences using the wrong products can have on the slip resistance of flooring surfaces.

 Separate cleaning materials and equipment between the front of the house and back of the house to reduce the likelihood of transporting a problem from one area to another. Color coding materials can provide instant recognition for personnel using the wrong equipment in the wrong area of the facility.

 Ensure that permanently installed features like carpet runners and mats are
included in the maintenance and housekeeping program. These materials need
to be regularly inspected for the buildup of contaminants and deterioration that could lead to the creation of fall hazards. Keep in mind that while mats reduce the likelihood of producing slips, improperly maintained mats can create trip hazards. Consider using mats that have been certified by the NFSI.

 Limit the difference in heights between flooring surfaces and mats to no more than ¼ to ½. Frequently inspect mats to ensure they have not buckled or curled. Make sure that your mats are firmly secured to the floor to prevent migration and that the floor beneath the mat is clean and dry. Make sure to evaluate the condition of these changes in height since they can deteriorate and create trip hazards.

 Regularly review all the slip-and-fall incident reports associated with your facility and understand the critical factors associated with them. Look for trends in location, time of day, etc., and focus staff training on your cleaning procedures for these factors. Train your workers how to properly respond to slip-and-fall incidents.

 Ensure that staff is well trained in spill prevention and response programs. They need to know where the materials are located and how to use them in the event of an emergency. Its also important that staff understand the importance of reporting incidents and conditions that could result in incidents, even if none have actually occurred. These will be your first indication of a potential issue that should be addressed.

 One of the surest ways to prevent the transmission of grease, water and other materials from the back of the house to the front of the house is to
implement a good mat program. Ensure the mats are frequently inspected and checked regularly for wear and the buildup of contaminants. A poorly managed and maintained mat program can significantly increase your likelihood of reducing the slip resistance of flooring surfaces.

 A walkway auditing program can help identify trends within your facility that can result in reduced slip resistance to flooring surfaces. To be effective, the testing should be completed in a consistent manner and include more than a single set of measurements. Consider using NFSI Certified walkway auditors. A complete list can be found on www.nfsi.org.

 Maintaining open and clear communication between the staff, cleaning personnel and the walkway floor auditor is crucial to the identification of trends and elimination of factors that could reduce the slip resistance on floor surfaces.


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## altered states (Feb 25, 2008)

moore2me said:


> Dear Tres huevos, I worked for over 20 years for state government and had a lot of dealing with our workers compensation system. Believe me, most injured workers are in NO way thinking "ka-ching". Getting hurt on the job is bad enough, but when you find out what you are entitled to, it's not worth ruining your body for such small monetary sums.



I wasn't talking about worker's comp (trust me!) - I was talking about suing. If people are constantly falling in the same place and it's been brought to management's attention, that's a pretty good case.


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## Pookie (Feb 26, 2008)

Thank you all for responding.

Yups, in the UK and despite having a friend who is a Personal Injury lawyers secretary I am not going to be suing my school, its just not the mentality I have.

I was very lucky to have managed to direct my fall somewhat, otherwise I would have broken my leg I am sure. What I am also concerned about is the fact it is a school kitchen... it makes me cringe thinking about what would happen should somebody slip while holding something hot. 

It has been reported with a workplace injury form, but my Dr's visit was after that initial filling out, so it has not been put on there. I feel as if I should press the matter, as its an outcome of the injury, I dont know if there are normally follow up procedures?

I am trying to manage my finances to make sure I get some input of protein everyday and I am making myself remember to take a multivitamin+extra iron, double dose of cod liver oil which I should be taking anyways and also brewers yeast. I didnt know magneaseum was useful, I am about to go google


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## Sandie S-R (Feb 26, 2008)

I was in a car accident many years ago, and I broke the steering column on my steering wheel as I was pushed into it rather stongly. A few days later, the biggest deepest bruise showed up on my tummy that was shaped exactly like the steering wheel. About a week after that I noticed a lump in my tummy about the size of a goose egg (where part of the bruise is). I went to the Doc. The Doc x-rayed and then palpated the area, and determined that it was a hematoma...as a result of the bruising. He said not to worry about it, and that it would eventually disappear. And I did, and it did. 

Are they sure it is not just a hematoma?


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## Pookie (Mar 5, 2008)

Ouch, Sandi, that sounds painful indeed.

The lump is irregular and a little moveable, so I am presuming the Dr is correct, he didnt suggest it could be anything else though


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