Surgical Treatment Guideline of Meningococal Induced Purpura Fulminans.

Kim, Eui Sik; Kim, Jeong Min; Yoo, Sung In; Noh, Bok Kyun; Hwang, Jae Ha; Kim, Kwang Seog; Lee, Sam Yong

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2007;34(1):77-80.
Published online January 1, 2007.

Surgical Treatment Guideline of Meningococal Induced Purpura Fulminans.

Eui Sik Kim, Jeong Min Kim, Sung In Yoo, Bok Kyun Noh, Jae Ha Hwang, Kwang Seog Kim, Sam Yong Lee

Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea. sylee@ chonnam.ac.kr

Abstract

PURPOSE
Purpura fulminans is a rare but rapidly progressive, serious, often life-threatening disorder in childhood, which is complicated with septic shock or disseminated intravascular coagulopathy during acute infection. It occurs first as acute-onset petechial rash, and spreads rapidly into full thickness skin and soft tissue necrosis. In the past, it had high mortality rate, up to 80%, but recently, survival rate has increased due to early diagnosis, and rapid advancement of critical care and antibiotics. From our experiences of PF management, we would like to review the pathophysiology and suggest the surgical treatment guideline about meningococcal induced purpura fulminans. METHODS: Two cases of purpura fulminans over the last 3 years were reviewed retrospectively about reconstructive management. After they were treated resuscitative management initially by the critical intensive care, reconstructive surgery was performed by plastic surgeon as soon as the patients were vitally and mentally stable.
RESULTS
There were 6 procedures in case 1, and 3 procedures in case 2. The mean delayed period from admission with sepsis to the first surgical debridement was 24 days and 42 days, respectively. Total hospitalization period was 103 days and 69 days, respectively. All of them were treated with debridement and split thickness skin graft, but delayed debridement was superior to early one in the point of preserving much more tissues.
CONCLUSION
From our experience, we suggest that conservative therapy to the wounds appears to be the best tool in the initial vitally unstable period in order to preserve as much tissues and functions as possible if no active inflammation and compartment syndrome are detective.

Keywords: Meningococcemia; Purpura fulminans

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