Reconstructive surgery in children after meningococcal purpura fulminans.
OBJECTIVE
Purpura fulminans (PF) is a serious, often life-threatening disease. As more children are surviving their disease, surgeons are presented with increasing numbers of multiple and complicated wounds as sequelae of PF. The purpose of this paper is to review the management of nine cases of PF, and present the reconstruction method in treating bilateral exposed elbow and knee joints.


METHODS
All cases of pediatric patients with PF and treated by the division of plastic and reconstructive surgery between 1986 and 1998 were reviewed.


RESULTS
Seven children (78%) had meningococcal PF, and one (11%) had PF after Haemophilus influenza septicemia. PF developed in one (11%) but with no growth in either blood or cerebrospinal fluid cultures. Five children (56%) required amputation procedures. Two children (22%) required knee disarticulation. Two patients (22%) had free myocutaneous flap transfers for bone coverage. One (11%) had PF involving the face.


CONCLUSIONS
Meningococcal PF is a rare, often life-threatening disease generally of childhood. More children are surviving their diseases but with devastating sequelae. Successful reconstructive treatment outcome of these children requires a multidisciplinary team approach involving multiple specialties. The goal is to preserve function, maintain maximal length, and salvage limbs when possible. Flexibility and innovation are necessary in treating these multiple and complicated wounds.
Huang
D B
DB
Division of Plastic and Reconstructive Surgery, Department of Orthopedic Surgery, Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, MO, USA.
Price
M
M
Pokorny
J
J
Gabriel
K R
KR
Lynch
R
R
Paletta
C E
CE
D000671:Amputation, Surgical; D002675:Child, Preschool; D003646:Debridement; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000601:surgery*; D008297:Male; D008589:Meningococcal Infections / Q000601:surgery*; D009345:Neisseria meningitidis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps