Acute Cutaneous Necrosis: A Guide to Early Diagnosis and Treatment

Abstract

Acute cutaneous necrosis is characterised by a wide range of aetiologies and is associated with significant morbidity and mortality, warranting complex considerations in management. Early recognition is imperative in diagnosis and management of sudden gangrenous changes in the skin. This review discusses major causes of cutaneous necrosis, examines the need for early assessment, and integrates techniques related to diagnosis and management. The literature, available via PubMed, on acute cutaneous necrotic syndromes was reviewed to summarise causes and synthesise appropriate treatment strategies to create a clinician's guide in the early diagnosis and management of acute cutaneous necrosis. Highlighted in this article are key features associated with common causes of acute cutaneous necrosis: warfarin-induced skin necrosis, heparin-induced skin necrosis, calciphylaxis, pyoderma gangrenosum, embolic phenomena, purpura fulminans, brown recluse spider bite, necrotising fasciitis, ecthyma gangrenosum, antiphospholipid syndrome, hypergammaglobulinemia, and cryoglobulinemia. This review serves to increase recognition of these serious pathologies and complications, allowing for prompt diagnosis and swift limb- or life-saving management.

Skin Wound Healing Process and New Emerging Technologies for Skin Wound Care and Regeneration

“…Wounds have a variety of causes, namely surgery, injuries, extrinsic factors (e.g., pressure, burns and cuts), or pathologic conditions such as diabetes or vascular diseases. These types of damage are classified into acute or chronic wounds depending on their underlying causes and consequences [ 4 ]. Acute wounds usually proceed through an organized and appropriate repair process, resulting in the sustained restoration of anatomical and functional integrity.…”

Emergency department visits due to the bleeding complication of warfarin

“…Skin necrosis is a rare complication which is observed 0.1- 1% of the warfarin users and frequently observed in the first week. [14,15] In our study, the female gender, low hemoglobin level, abnormal liver and kidney functions, INR level over 10 and irregular INR follow up were associated with both mortality and major bleeding. The warfarin usage education in anticoagulation clinics or units decreases the complications and increases patient compliance.…”

Breast necrosis in a chronic user of warfarin

“…The treatment of warfarin-induced breast necrosis, although not interfering with the progression of gangrene, should begin as early as possible in order to avoid related complications, such as secondary infections. It consists in the administration of low-molecular weight heparin doses enough for full anticoagulation, oral anticoagulant suspension, administration of fresh plasma and vitamin K, thus restoring proteins C and S through hepatic production stimulation 29 . The use of new oral anticoagulants with different action mechanism, such as direct thrombin inhibitors of the Xa factor, is also advocated 30 .…”

“…The use of new oral anticoagulants with different action mechanism, such as direct thrombin inhibitors of the Xa factor, is also advocated 30 . Currently, despite proper treatment, more than half of the patients will require surgical debridement, amputation or total mastectomy [19][20][21][22]24,26,29 .…”