Delayed Surgical Debridement and Use of Semiocclusive Dressings for Salvage of Fingers After Purpura Fulminans.
Background:Purpura fulminans is a condition characterized by rapidly evolving skin necrosis and disseminated intravascular coagulation. Early recognition and aggressive supportive management has led to a decrease in its mortality rate, but most of these patients must undergo extensive soft tissue debridement and partial or total limb amputation. There is controversial evidence about the timing of surgery, suggesting that some patients may benefit from delayed debridement with limb preservation.Methods:We present a case of an 86-year-old patient who developed skin necrosis of his four limbs after infectious purpura fulminans. He was treated in the ICU with supportive measures and antibiotic treatment. Surgical debridement was delayed for 4 weeks until necrosis delimitation.Results:Only upper extremity debridement was necessary. Four fingers, including one thumb, were salvaged and successfully treated with semi-occlusive dressing without complications.Conclusion:Early recognition of infectious PF and timely supportive management are important pillars of its treatment. Delayed surgical debridement allows for less aggressive resection and good functional outcome.
Pontificia Universidad Católica de Chile, Santiago, Chile.
Paula A
PA
Pino
Pontificia Universidad Católica de Chile, Santiago, Chile.
Javier A
JA
Román
Pontificia Universidad Católica de Chile, Santiago, Chile.
Felipe
F
Fernández
D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001458:Bandages; D003646:Debridement / Q000379:methods*; D005385:Fingers / Q000601:surgery*; D006801:Humans; D008297:Male; D055665:Purpura Fulminans / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors
amputation; disseminated intravascular coagulation; finger necrosis; purpura fulminans; semiocclusive dressing; symmetric peripheral gangrene