INTEGRA ARTIFICIAL SKIN AS A USEFUL ADJUNCT IN THE TREATMENT OF PURPURA FULMINANS

Purpura fulminans is a devastating disorder characterized by rapidly p rogressing hemorrhagic necrosis of the skin, vascular collapse, and di sseminated intravascular coagulation. It is most often seen in childre n, and it is usually preceded by meningococcemia or another infection. Most often, the disorder results in severe skin loss, but it can also result in the need for extremity amputations. In extreme cases, wound coverage after excision may be problematic because of the limited exi stence of donor sites and the need for amputation revisions. The case of a 2 1/2-year-old male requiring amputations of all four extremities due to severe purpura fulminans is presented to illustrate the use of Integra Artificial Skin (Integra Lifesciences Corp., Plainsboro, NT) to obtain immediate wound closure. Integra Artificial Skin is a bilaye red skin substitute that engrafts to a viable wound bed. In the case p resented here, where the viability of the underlying tissue of the amp utated stumps was questionable, the artificial skin acted as an indica tor of that viability. It engrafted well onto the upper extremity stum ps, which were of excellent viablity, but it needed to be replaced on the lower extremity stumps, which required further debridement and amp utation revisions. The use of artificial skin spared the patient the i mmediate use of his limited and valuable autograft sites. In conclusio n, Integra Artificial Skin can be a useful adjunct in the treatment of severe purpura fulminans that includes skin and extremity necrosis.