Biscoe Anna Louise, Bedlow Alison
Warwick Medical School, Warwick University, Coventry, UK.
BMJ Case Rep. 2013 Jan 28;2013:bcr2012007455. doi: 10.1136/bcr-2012-007455.
A patient with a history of deep vein thrombosis presented with painful bruising and blistering on his left leg 7-10 days after warfarin treatment. A complicated 2-month treatment followed, where vasculitis was originally diagnosed from histological findings before the final diagnosis of warfarin-induced skin necrosis (WISN) was made on clinical grounds. Warfarin was stopped, reversed and low molecular weight heparin started but, the lesions had progressed to full thickness necrosis. This was originally treated with conventional surgical debridement before introducing maggot debridement therapy (MDT) in an effort to try to salvage the limb.
一名有深静脉血栓形成病史的患者在接受华法林治疗7 - 10天后，左腿出现疼痛性瘀斑和水疱。随后进行了为期2个月的复杂治疗，最初根据组织学检查结果诊断为血管炎，之后根据临床依据最终诊断为华法林诱导的皮肤坏死（WISN）。停用华法林并进行逆转，同时开始使用低分子肝素，但病变已发展为全层坏死。最初采用传统手术清创治疗，之后引入蛆虫清创疗法（MDT），试图挽救肢体。
