Skin necrosis and the need for vascular assessments

Abstract

There are many causes of skin necrosis. The process resulting in skin necrosis begins with the sudden thrombotic occlusion of single or multiple blood vessels supplying the tissue. Compromised blood vessels leak red cells into the surrounding tissues where they become trapped within the ensuing tissue that is turning necrotic. The subsequent deoxygenation of haemoglobin in the red blood cells causes tissue hypoxia and renders it black in colour. While tissue is dying, cells release cytokines promoting inflammation. At the boundary of necrotic tissue, blood vessels dilate resulting in hyperaemia giving rise to the dusky grey–red colour of the surrounding skin. Thus, the successful diagnosis of skin necrosis depends upon the identification of the condition that causes vessel thrombosis.