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.
KEYWORD
Purpura fulminans - childhood - microsurgery
