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Amputation following meningococcemia. A sequela to purpura fulminans
Abstract:
In five patients with purpura fulminans following meningitis, gangrene of the extremities developed. Four patients required amputations of the lower extremities and two patients of the upper extremities. The gangrene is caused by disseminated intravascular coagulation. In two patients epiphyseal damage and subsequent angular deformities developed. The orthopedic surgeon should be consulted early because aponeurectomy may save an extremity. Some method of temporary skin coverage should be considered at the time of initial debridement and aponeurectomy. Early skin grafts are frequently rejected because the extent of necrosis has not declared itself, necessitating further grafting, which results in multiple painful and unsightly donor scars. Stump problems due to less than satisfactory skin coverage, stump overgrowth, joint contractures, and epiphyseal damage are later complications.
Insights
Purpura fulminans can cause limb gangrene, often requiring amputation. Early orthopedic consultation and surgical intervention, like aponeurectomy, may save extremities from this severe complication.
Area of Science:
- Medical Science
- Orthopedic Surgery
- Pediatric Infectious Disease
Background:
- Purpura fulminans is a rare, life-threatening complication of bacterial meningitis.
- It leads to disseminated intravascular coagulation (DIC), causing tissue necrosis and gangrene.
Purpose of the Study:
- To highlight the orthopedic complications of purpura fulminans.
- To emphasize the importance of early surgical intervention in managing extremity gangrene.
Main Methods:
- Case series review of five patients with purpura fulminans post-meningitis.
- Analysis of orthopedic sequelae, including gangrene, amputations, and epiphyseal damage.
Main Results:
- Five patients developed extremity gangrene; four required lower extremity amputations, and two required upper extremity amputations.
- Two patients experienced epiphyseal damage leading to angular deformities.
- Delayed or inappropriate skin grafting led to complications like donor scars and stump problems.
Conclusions:
- Early orthopedic consultation and procedures like aponeurectomy are crucial for limb salvage.
- Temporary skin coverage strategies should be considered during initial debridement.
- Addressing stump problems and epiphyseal damage requires a multidisciplinary approach.