Orthopaedic Short Stories

Warfarin induced skin necrosis following TKR
Case Report

This 67 year old female underwent an uneventful total knee replacement and was routinely placed on low dose warfarin postoperatively for DVT prophylaxis. One week later she arrived in clinic with a two by three centimeter area of skin necrosis about the lateral skin flap. She was admitted for prophylactic antibiotics and possible wound debridement. The area of necrosis spread from the original site overnight and the knee was covered with a large area of ecchymosis, bullae, and spreading necrosis.

1 - total knee ten days after implantation.
3 - after first debridement.

Immediate local debridement was performed but the area of necrosis kept spreading beyond the edges of the wound. The patient also developed similar areas about her abdomen.

2 - abdominal lesions.

Further debridement was necessary to stem the spread of the lesions. Coumadin was stopped by this time and the wound stabilized.

4 - granulating wound after arresting spread of process.

Plastic surgery was consulted to provide skin and muscle coverage. STSG and gastrocnemius flaps were necessary to cover the wounds.

5 6 7

appearance of wounds 18 months after injury - knee is now painless with a range of motion of 10 to 70 degrees. Note donor site on contralteral leg.

Home Medical Education Table of Contents Discussion
Last modified 27/August/1999 by IS