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Sequential microsurgical flap reconstruction following purpura fulminans during infancy and childhood
A Jester1, K L Waag, G Germann
1Department of Hand, Plastic and Reconstructive Surgery-Burn Centre-BG-Trauma Center Ludwigshafen, Germany.
Abstract:
Purpura fulminans is a potentially lethal complication of meningococcal septicemia, characterized by progressive hemorrhagic skin lesions, which can result in extensive necrosis and mummification of all the extremities. With improving survival rates in infancy and childhood, plastic surgeons are challenged more often to provide sufficient and stable soft-tissue coverage. Usually, conservative methods, such as skin grafting or amputation, are favored by many pediatric surgeons, since further specialized departments and training are not required. Often secondary reconstructive procedures to improve soft-tissue coverage have to be performed to achieve proper prosthetic fitting. Microsurgical techniques are used only in selected cases, after failure of other procedures for defect coverage. In two cases of post-acute purpura fulminans, two free flaps and three microsurgically dissected flaps were used as primary measures for defect coverage and preservation of stump length. Despite the presence of vasculitis, all flaps survived. In a third case, secondary reconstructive measures had to be performed 1 year after purpura fulminans due to insufficient soft-tissue coverage after lower leg amputation. This patient also had contractures on both hands and no grip function after complete finger loss. Several microsurgical procedures were performed to improve grip function and soft-tissue coverage. The primary use of microsurgical techniques prevents lengthy secondary reconstructive measures.
Insights
Early use of microsurgical techniques in purpura fulminans can prevent extensive reconstructive surgeries. This approach aids in preserving stump length and improving function after meningococcal septicemia complications.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Vascular Surgery
Background:
- Purpura fulminans, a severe complication of meningococcal septicemia, presents with extensive skin necrosis, challenging pediatric plastic surgeons.
- Improving survival rates necessitate advanced reconstructive strategies for soft-tissue coverage and limb preservation.
Observation:
- Conservative treatments like skin grafting or amputation are common but often require secondary procedures.
- Microsurgical techniques were employed as primary reconstructive measures in two cases for defect coverage and stump length preservation.
- One case required secondary reconstruction after amputation due to insufficient soft-tissue coverage and functional deficits.
Findings:
- All microsurgically reconstructed flaps survived despite underlying vasculitis.
- Primary microsurgical intervention successfully prevented lengthy secondary reconstructive measures in selected cases.
- Microsurgery also addressed functional deficits like contractures and loss of grip function.
Implications:
- Early adoption of microsurgical techniques can significantly improve outcomes for purpura fulminans survivors.
- This approach reduces the need for multiple surgeries, enhancing patient quality of life.
- Microsurgery offers a viable solution for complex soft-tissue defects and functional restoration in pediatric patients.