Reconstructive surgery in children after meningococcal purpura fulminans

Background/Purpose: Purpura fulminans (PF) is a serious, often life-threate ning disease. As more chilren are surviving their disease, surgeons are pre sented with increasing numbers of multiple and complicated wounds as sequel ae of PF. The purpose of this paper is to review the management of nine cas es of PF, and present the reconstruction method in treating bilateral expos ed elbow and knee joints. Methods: All cases of pediatric patients with PF and treated by the divisio n of plastic and reconstructive surgery between 1986 and 1998 were reviewed . Results: Seven children (78%) had meningococcal PF, and one (11%) had PF af ter 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 disartic ulation. Two patients (22%) had free myocutaneous flap transfers for bone c overage. One (11%) had PF involving the face. Conclusions: Meningococcal PF is a rare, often life-threatening disease gen erally of childhood. More children are surviving their diseases but with de vastating sequelae. Successful reconstructive treatment outcome of these ch ildren requires a multidisciplinary team approach involving multiple specia lties. The goal is to preserve function, maintain maximal length, and salva ge limbs when possible. Flexibility and innovation are necessary in treatin g these multiple and complicated wounds. Copyright (C) 1999 by W.B. Saunder s Company.