This case report highlights the risk of donor-site conversion in the setting of necrotizing cryoglobulinemic vasculopathy. Because no single treatment modality has been shown to be consistently effective, a multidisciplinary approach provides the best prospect for disease control and ulcer healing. Medical therapy through plasma exchange reduces the quantity of cryoglobulins, whereas immunosuppression attempts to reduce the degree and effects of cryoprecipitation. If thorough conservative care fails, consideration for surgical management should include minimizing the size of the split-thickness skin graft donor site because of the high risk of donor-site conversion. Warmed rooms and intravenous fluids and the use of occlusive dressings may reduce the chance of cryoglobulin deposition in the vasculature, a rather unusual complication of cryoglobulinemia.
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