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Updated: Aug 15, 2026
Engineered Vascularized Muscle Flap
Published on: January 11, 2016
Soft-tissue reconstruction after meningococcal septicemia using a posterior tibial artery perforator flap in a
1Aesthetic Surgical Associates, 3601 Houma Boulevard, Suite 300, Metairie, LA, 70006, USA. drguerra@gmail.com
Abstract:
Fulminant meningococcemia can have life-threatening as well as limb-threatening complications. However, unlike other types of peripheral gangrene, areas of necrosis do not follow known anatomic vascular patterns. Instead, irregular and patchy areas of necrosis are found to exist adjacent to viable tissues. With improved critical care, more patients survive the initial insult and are referred for reconstructive procedures. In this case, a 6-year boy was diagnosed with meningococcemia-induced purpura fulminans. After stabilization, he was transferred to our facility for management of open wounds of both lower extremities and the left elbow. Soft-tissue coverage was accomplished after multiple debridements using various flaps. In particular, a defect of the right midtibia was reconstructed using a posterior tibial artery perforator-based flap with excellent results. This is the first time such a flap has been reported in association with meningococcemia in a patient of this age.
Insights
Fulminant meningococcemia can cause severe tissue death. A posterior tibial artery perforator flap successfully reconstructed a leg defect in a child, marking a novel approach for this condition.
Area of Science:
- Pediatric reconstructive surgery
- Infectious disease complications
- Vascular surgery
Background:
- Fulminant meningococcemia presents with life- and limb-threatening complications, including peripheral gangrene.
- Necrotic patterns in meningococcemia differ from typical vascular gangrene, appearing as irregular patches adjacent to viable tissue.
- Advances in critical care increase survival rates, leading to more patients requiring reconstructive surgery for tissue defects.
Purpose of the Study:
- To report a case of successful soft-tissue reconstruction in a child with meningococcemia-induced purpura fulminans.
- To highlight the use of a posterior tibial artery perforator-based flap for limb salvage in this specific context.
- To document the first reported use of this flap technique in a pediatric patient with meningococcemia.
Main Methods:
- A 6-year-old boy diagnosed with meningococcemia-induced purpura fulminans was treated.
- Following initial stabilization, the patient underwent multiple debridements for open wounds on lower extremities and left elbow.
- A posterior tibial artery perforator-based flap was utilized to reconstruct a defect on the right midtibia.
Main Results:
- Successful soft-tissue coverage was achieved using various flap techniques.
- The posterior tibial artery perforator-based flap provided excellent reconstruction of the right midtibia defect.
- The patient experienced positive outcomes following the reconstructive procedures.
Conclusions:
- Reconstructive surgery plays a vital role in managing limb-threatening complications of meningococcemia.
- Posterior tibial artery perforator flaps are a viable option for soft-tissue reconstruction in pediatric patients with meningococcemia-induced defects.
- This case demonstrates the successful application of a perforator flap in a pediatric patient, expanding reconstructive options for purpura fulminans.
