Plastic surgery management of soft tissue loss in meningococcal septicemia: experience of the Melbourne Royal Children's Hospital.
Soft tissue necrosis associated with meningococcemia is a major challenge for any pediatric plastic surgery service. Records of patients treated by the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia, were reviewed. Two hundred fifty patients were treated for meningococcemia at our institution over a 40-year period. Of these, 31 patients suffered soft tissue necrosis. Three groups were identified: lesions that healed with nonoperative management (n = 12); those that required skin grafting, flaps, or minor amputations (n = 14); and those requiring major amputations (n = 5). When compared with a comparable control group of patients with documented meningococcemia who did not suffer tissue loss (n = 35), the best predictors for requiring surgery were the presence of metabolic acidosis on admission (P < 0.0005) and a progressive thrombocytopenia (P < 0.0005). Metabolic acidosis and progressive thrombocytopenia are predictive of the need for surgery for tissue loss and underline the evolving thrombotic nature of the disease.
Penington
Anthony J
AJ
Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia. a.penington@unimelb.edu.au
Craft
Randall O
RO
Tilkorn
Daniel J
DJ
D000671:Amputation, Surgical; D001315:Australia; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D009336:Necrosis / Q000382:microbiology* / Q000601:surgery*; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D019651:Plastic Surgery Procedures / Q000379:methods*; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery*; D016038:Skin Transplantation; D018461:Soft Tissue Infections / Q000382:microbiology* / Q000473:pathology*