title: Limb fitting for quadruple amputees: report of two cases of symmetrical peripheral gangrene caused by pneumococcal purpura fulminans.
abstract: BACKGROUND
  We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans.
  
  
  METHODS
  The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock.
  
  
  RESULTS
  The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases.
  
  
  CONCLUSIONS
  Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability.
authors.affiliation: 1Department of Rehabilitation Medicine, Hospital for National Rehabilitation Center, Tokorozawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuma
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Tomoki
authors.initials: T
authors.lastname: Mita
authors.forename: Atsuko
authors.initials: A
authors.lastname: Mitsumoto
authors.forename: Nobuya
authors.initials: N
authors.lastname: Yamasaki
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Tobimatsu
authors.forename: Masami
authors.initials: M
authors.lastname: Akai
mesh_terms: D000203:Activities of Daily Living; D000672:Amputation Stumps; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D005269:Femur / Q000601:surgery; D005734:Gangrene / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000150:complications*; D017755:Prosthesis Fitting; D055665:Purpura Fulminans / Q000150:complications*; D011884:Radius / Q000601:surgery; D013977:Tibia / Q000601:surgery
keywords: Rehabilitation of amputees; prosthetic rehabilitation; purpura fulminans; quadruple amputation