title: Nose and upper lip reconstruction for purpura fulminans.
abstract: BACKGROUND
  Purpura fulminans (PF) is a rare syndrome of intravascular thrombosis and haemorrhagic infarction of the skin. The initial symptom of PF is peripheral purpura which progresses to necrosis very rapidly. The prognosis of PF is poor, and the mortality is reported to be around 40%. Even if the patient survives, the patient may require amputation or reconstruction for limbs and facial necrosis.
  
  
  METHODS
  A 48-year-old male suffered from PF following a left cerebellopontine angle tumour excision. His nose and upper lip fell into necrosis afterwards. We performed nose and upper lip reconstruction at 8 months after the onset. We used a forehead flap for the nasal reconstruction and a free forearm flap for the lining. His upper lip was reconstructed with bilateral nasolabial orbicularis oris myocutaneous flaps.
  
  
  RESULTS
  The colour and texture match of the reconstructed nose and lip is good. He could open his mouth wide enough and close completely.
  
  
  CONCLUSIONS
  Facial reconstruction after PF is very difficult, because the patient has extensive scarring around the defect and there is little intact facial tissue. However, we performed a facial reconstruction using local flaps as much as possible, and obtained good results.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hirosaki University School of Medicine, 52 Hontyou, Hirosaki, Aomori 036-8563, Japan. urushi@cc.hirosaki-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Urushidate
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yokoi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Higuma
authors.forename: Makoto
authors.initials: M
authors.lastname: Mikami
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Makiko
authors.initials: M
authors.lastname: Saito
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Saito
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Yotsuyanagi
mesh_terms: D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery; D005546:Forehead / Q000601:surgery; D006801:Humans; D008046:Lip / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D009666:Nose / Q000601:surgery*; D055665:Purpura Fulminans / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps