Warfarin skin necrosis: Local and systemic factors

Warfarin induced skin necrosis occurs in 0.01-0.1% of warfarin treated pati ents. The usual presentation is that of painful lesions developing in obese women after the initiation of warfarin treatment. The lesions usually evol ve into full thickness skin necrosis within a few days. Although the exact mechanism is not totally clear, low levels of Protein C or S, either functi onal or inherited, are associated with many of the cases. We report the cas e of a 17-year-old patient treated with warfarin because of iliofemoral dee p vein thrombosis post abortion. The patient developed several huge haemorr hagic blisters on the affected leg. The condition rapidly developed into fu ll thickness skin and fat necrosis. The necrotic lesions were excised and e ventually covered with skin graft. The combination of the patient tendency towards hyper-coagulation and the local factors is discussed. (C) 2000 The British Association of Plastic Surgeons.