Warfarin induced skin necrosis is a rare debilitating and, in some cases, life-threatening complication. A 47-year-old male on life-long anticoagulation omits his medication and develops extensive skin necrosis of the left leg complicated by acute renal failure three days after restarting warfarin. Investigations reveal possible Protein S deficiency which is known to be a predisposing condition. Various mechanisms have been proposed as the underlying cause. He was managed on heparin, wound debridement and skin grafting. Warfarin was restarted concurrently with heparin. Knowledge of this complication will enable timely diagnosis and treatment.