Excessive Internal Pressure (Dissecting Hematoma, Abdominal Hyperpressure, Abscesses, etc.) Leading to Skin Necrosis

An excessive internal pressure exerted over the skin by a liquid, semiliquid collection, or hardware located between the muscles, fascias, tendons, or bone, pushing externally from inside and crushing the skin surface, may lead to sin necrosis. This situation contributes to extensive tissue damages. Several clinical contexts may be categorized as excessive internal pressure, leading to skin necrosis, like dissecting hematoma, purulent abscesses observed in diabetic foot ulcers, or abnormal anatomical situations as abdominal hyperpressure exerting an excessive tension over an abdominal wall having lost the muscular structures, in secondarily closed eviscerations or congenital hernias. Strategies depend on the original cause, and therapeutic options may vary from rapid evacuation of a collection, drainage of pus, reinforcement of the skin structure using dermal substitutes, or skin replacement using composite flaps.