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Prothrombotic evaluation showed homozygosity for the factor V Leiden (<jats:styled-content style=\"fixed-case\">FVL<\/jats:styled-content>) mutation. Therapeutic anticoagulation was commenced with warfarin (Coumadin\u00ae) and the patient underwent successful debridement and Apligraf\u00ae followed by split\u2010thickness skin graft (<jats:styled-content style=\"fixed-case\">STSG<\/jats:styled-content>) of two wounds. He had an uneventful postoperative course and on the 27th postoperative day the grafts were 95% intact. However, by postoperative day 41 there was 10% graft loss, and over the subsequent 2\u2009weeks both grafts necrosed. On further questioning, it transpired that the patient had discontinued his warfarin on postoperative day 37 because he thought that it was no longer necessary. The patient is enrolled in the Wound Etiology and Healing (<jats:styled-content style=\"fixed-case\">WE\u2010HEAL<\/jats:styled-content>) study, and at the time of the original graft, residual skin fragments from the <jats:styled-content style=\"fixed-case\">STSG<\/jats:styled-content> were transplanted onto a nude mouse for development of an animal model of wound healing. The mouse graft was successful and was harvested at postoperative day 87 for pathological examination. We review the mechanisms by which prothrombotic states, particularly <jats:styled-content style=\"fixed-case\">FVL<\/jats:styled-content> mutation, can contribute to skin graft failure and delayed wound healing. This case highlights the importance of considering prothrombotic conditions in patients with spontaneous leg ulcerations and the impact of therapeutic anticoagulation on healing. It further allows us to demonstrate the efficacy of the animal model in which residual fragments of <jats:styled-content style=\"fixed-case\">STSG<\/jats:styled-content> tissue are utilised for transplant onto nude mice for manipulation in the laboratory.<\/jats:p>","DOI":"10.1111\/iwj.12156","type":"journal-article","created":{"date-parts":[[2013,9,13]],"date-time":"2013-09-13T08:55:01Z","timestamp":1379062501000},"page":"537-544","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Late failure of a split\u2010thickness skin graft in the setting of homozygous factor V Leiden mutation: a case report and correlative animal model from the Wound Etiology and Healing (WE\u2010HEAL) study"],"prefix":"10.1111","volume":"12","author":[{"given":"Victoria K","family":"Shanmugam","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Immunology and Allergy MedStar Georgetown University Hospital Washington DC 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