[Management of purpura fulminans lesions in children].
Purpura fulminans is a pediatric life-threatening emergency with a significant mortality, combining: septic shock, extensive purpuric lesions and disseminated intravascular coagulation. The most frequent bacterial pathogen is the meningococcus. The medical management includes antibiotics, corticoids, vascular filling and catecholamines. Purpura fulminans is characterized by the extent of hemorrhagic and mainly thrombotic lesions, attributed to the alteration in the vascular endothelium functions. Damage of soft tissues combines large necrotic areas and more or less extensive distal ischemic lesions. Necrotic lesions can be deep, reaching skin, subcutaneous tissue, fascia, muscle and sometimes even the bone. The importance of the aesthetic and functional sequelae as well as future quality of life, depend on the quality of surgical management for these wide and deep lesions. Fasciotomy is sometimes urgently needed in the case of a clinical compartment syndrome, confirmed by a high-pressure measurement in the muscle compartments. Debridement of necrotic lesions and amputations are only performed after a clear delineation of necrotic areas, between 10 days and 3 weeks of evolution. If an amputation is necessary, it must focus on the residual bone length, considering the child's growth potential. The coverage of tissue loss uses all the plastic surgery techniques, more or less complex, in order to reduce scars to minimum for these children. Rehabilitation follow-up includes physical and psychological care, which are essential until adulthood.
Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France. Electronic address: louise.pasquesoone@chru-lille.fr.
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Pasquesoone
Clinique de chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59000 Lille, France.
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Belkhou
Centre de rééducation Marc-Sautelet, 10, rue du Petit-Boulevard, 59650 Villeneuve-d'Ascq, France.
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Gottrand
Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
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Guerreschi
Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
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Duquennoy-Martinot
D000465:Algorithms; D000671:Amputation, Surgical; D002648:Child; D004630:Emergencies; D006801:Humans; D009336:Necrosis; D055665:Purpura Fulminans / Q000601:surgery*; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation; D013524:Surgical Flaps
Amputation; Nécroses cutanées; Prise en charge chirurgicale; Purpura fulminans; Reconstruction; Skin necroses; Surgical procedures