Reconstructive surgery in children after meningococcal purpura fulminans
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Published on: June 3, 2022
D B Huang1, M Price, J Pokorny
1Division of Plastic and Reconstructive Surgery, Department of Orthopedic Surgery, Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, MO, USA.
Insights
Purpura fulminans (PF) is a severe childhood disease. This study reviews surgical reconstruction for complicated PF wounds, emphasizing limb salvage and function preservation through a multidisciplinary approach.
Area of Science:
- Pediatric Surgery
- Plastic and Reconstructive Surgery
- Infectious Disease Complications
Background:
- Purpura fulminans (PF) is a rare, life-threatening condition, often affecting children.
- Increasing survival rates from PF lead to complex surgical challenges due to severe sequelae.
- Management of extensive wounds and joint exposure is critical for long-term patient outcomes.
Observation:
- Meningococcal PF was the most common etiology (78%), followed by Haemophilus influenza (11%).
- A significant proportion of patients (56%) required amputations, with 22% undergoing knee disarticulation.
- Reconstructive techniques included free myocutaneous flap transfers for exposed bone coverage.
Findings:
- Surgical reconstruction is crucial for managing the devastating sequelae of PF in pediatric survivors.
- Successful outcomes necessitate a multidisciplinary approach involving various surgical and medical specialties.
- Techniques focus on preserving limb function and maximizing length, even in severe cases.
Implications:
- Highlights the need for specialized reconstructive surgical expertise in managing PF survivors.
- Emphasizes the importance of a collaborative, multidisciplinary team for optimal patient outcomes.
- Underscores the necessity of innovative and flexible surgical strategies for complex limb reconstruction in pediatric PF patients.
Background/Purpose:
Purpura fulminans (PF) is a serious, often life-threatening disease. As more children are surviving their disease, surgeons are presented with increasing numbers of multiple and complicated wounds as sequelae of PF. The purpose of this paper is to review the management of nine cases of PF, and present the reconstruction method in treating bilateral exposed elbow and knee joints.
Methods:
All cases of pediatric patients with PF and treated by the division of plastic and reconstructive surgery between 1986 and 1998 were reviewed.
Results:
Seven children (78%) had meningococcal PF, and one (11%) had PF after Haemophilus influenza septicemia. PF developed in one (11%) but with no growth in either blood or cerebrospinal fluid cultures. Five children (56%) required amputation procedures. Two children (22%) required knee disarticulation. Two patients (22%) had free myocutaneous flap transfers for bone coverage. One (11%) had PF involving the face.
Conclusions:
Meningococcal PF is a rare, often life-threatening disease generally of childhood. More children are surviving their diseases but with devastating sequelae. Successful reconstructive treatment outcome of these children requires a multidisciplinary team approach involving multiple specialties. The goal is to preserve function, maintain maximal length, and salvage limbs when possible. Flexibility and innovation are necessary in treating these multiple and complicated wounds.
