title: Conservative surgical management of necrotic tissues following meningococcal sepsis: case report of a child treated with hyperbaric oxygen.
abstract: This article presents the case of a 5-month-old infant, who survived a fulminant meningococcal sepsis with purpura fulminans, septic shock and severe DIC with gastrointestinal bleeding. Amputation and reconstructive surgery were considered to treat the multiple skin and limb necroses at high risk of superinfection, but the surgical intervention was delayed due to the extremely doubtful outcome. On Day 10 after the onset of the disease, a hemodynamic improvement was achieved. The baby overcame early critical period, but was still in poor general condition. The hyperbaric oxygenation (HBO2) as adjuvant therapy was started in the monoplace chamber using the following protocol: from first through fifth day 45 minutes twice a day on 1.5 atmosphere absolute (ATA); after a two-day break, once a day on 1.8 ATA for 60 minutes. During 52 HBO2 treatments multiple areas of necrotic skin and subcutaneous tissue, together with fingertips and toes, detached spontaneously. All wounds healed without reinfections. An increased oxygen concentration during HBO2 therapy promoted spontaneous wound healing. Bacterial superinfection was not observed in numerous low-perfused lesions. Since repeated anesthesia and surgical interventions were not needed, a final invalidity was minimized. To the best of our knowledge, this is the first report on the successful conservative surgical treatment of this mutilating disease without aggressive reconstructive surgery in an infant with the help of HBO2.
authors.affiliation: Department of Anesthesiology & ICU, Clinical Hospital Osijek, J Huttlera 4, Osijek, Croatia.
authors.forename: Ines
authors.initials: I
authors.lastname: Takac
authors.forename: Slavica
authors.initials: S
authors.lastname: Kvolik
authors.forename: Dalibor
authors.initials: D
authors.lastname: Divkovic
authors.forename: Jasenka
authors.initials: J
authors.lastname: Kalajdzic-Candrlic
authors.forename: Silvija
authors.initials: S
authors.lastname: Puseljic
authors.forename: Senka
authors.initials: S
authors.lastname: Izakovic
mesh_terms: D002985:Clinical Protocols; D005528:Foot / Q000473:pathology; D005734:Gangrene / Q000473:pathology / Q000628:therapy; D006225:Hand / Q000473:pathology; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000150:complications* / Q000628:therapy; D038581:Neisseria meningitidis, Serogroup Y; D055665:Purpura Fulminans / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D018805:Sepsis / Q000150:complications* / Q000628:therapy; D012772:Shock, Septic / Q000209:etiology / Q000628:therapy; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology