Heparin-Induced Skin Necrosis

G.C.M. Lieve Christiaens, M.D., Ph.D., and H. Karel Nieuwenhuis, M.D., Ph.D.

N Engl J Med 1996; 335:715September 5, 1996

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Figure 1 A 36-year-old woman received prophylactic subcutaneous heparin injections after an elective cesarean section. On the fifth postoperative day, subcutaneous edema, redness, and pain developed at the injection site, and heparin was discontinued. The next day, central necrosis of the lesion developed, with a clear line of demarcation between the affected area and surrounding tissue (the diameter of the lesion was 20 cm). The patient did not have thrombocytopenia or thrombotic complications. She also had normal plasma concentrations of protein C and protein S. The lesion later became bullous, with subsequent necrosis of the entire lesion, and skin grafting was required.

Kim Eagle, M.D.

G.C.M. Lieve Christiaens, M.D., Ph.D.
H. Karel Nieuwenhuis, M.D., Ph.D.
University Hospital Utrecht, Utrecht, the Netherlands

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