| Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Clinical Hemorheology and Microcirculation | ||||
| Publisher: | IOS PRESS | ||||
| Place of Publication: | AMSTERDAM | ||||
| Volume: | 75 | ||||
| Number of Issue or Book Chapter: | 3 | ||||
| Page Range: | pp. 267-278 | ||||
| Date: | 2020 | ||||
| Institutions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Plastische-, Hand- und Wiederherstellungschirurgie | ||||
| Identification Number: |
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| Keywords: | MENINGOCOCCAL SEPTICEMIA; MANAGEMENT; SKIN; SHOCK; Purpura fulminans; symptoms; surgical management; intensive care management; Idiopathic Thrombocytopenic Purpura; Disseminated Intravascular Coagulation; Acquired Protein C Deficiency; Sepsis; Neisseria meningitidis; Menigococcal sepsis; streptococcus pyogenes; herpes simplex virus | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 50463 |
Web of ScienceAbstract
BACKGROUND: Purpura fulminans (PF) is a distinct form of rare meningococcal septicaemia mostly in childhood which is characterized by high lethality, extensive necroses and mutilations of extremities. Other ethiologies are idiopathic forms or purpura neonatorum, which is marked by deficiency of Protein-C. PF is caused by micro-embolism of the vascular system, followed by quickly spreading ...
Abstract
BACKGROUND: Purpura fulminans (PF) is a distinct form of rare meningococcal septicaemia mostly in childhood which is characterized by high lethality, extensive necroses and mutilations of extremities. Other ethiologies are idiopathic forms or purpura neonatorum, which is marked by deficiency of Protein-C. PF is caused by micro-embolism of the vascular system, followed by quickly spreading necroses of skin and different organs. Modern concepts of intensive care treatment of the acute phase of this disease and early surgical intervention lead to a rising number of surviving patients requiring limb salvage. Aim of this study is to evaluate a possible lower morbidity and the grade of lower loss of function because of early surgical intervention. PATIENTS AND METHODS: Between the years 1998 and 2017 eight cases of PF at two large centers for critical wound care, the department of plastic-, handand reconstructive surgery of the university hospital of Regensburg and the department of plastic-, handand reconstructive surgery of the BG-clinic Ludwigshafen were included into our study. We retrospectively examined patients with PF who were stabilized by intensive care medicine and received surgical interventions. After survival of the acute phase (10 days), patients received plastic surgical reconstructions. RESULTS: A total number of eight patients could be included into our study. All patients survived the initial phase (10 days). All patients required plastic-surgical interventions to address extensive skin and soft tissue defects. Flap operations were judged necessary in five cases. Hereby four defects could be reconstructed by free tissue transfer, one with a local flap. Flap survival was 100 percent. One flap required revision of the arterial anastomosis of the flap arteria. Another flap got partial necrosis. One patient died due to multiorgan failure. Early debridements with consequent fasciotomies and secondary plastic-surgical reconstruction achieved good functional results. Limb salvage was accomplished in three patients. One patient died due to fulminant progress of the disease. CONCLUSION: Management of PF requires a multidisciplinary approach and close communication between the different subspecialties. Early debridements with consequent fasciotomies showed good results in salvaging subfascial muscle tissue in the extremities with satisfying functional results. Early surgical intervention is an important factor for improved limb salvage and survival.
Metadata last modified: 11 Oct 2021 13:05
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