Purpura fulminans skin loss: surgical management protocols at a regional burns centre

K. Lowery, R. Shirley, O. P. Shelley, M. Kaniorou-Larai, B. Philp, P. Dziewulski

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

People with significant skin loss after sepsis frequently require skin grafting; as such, they are often referred to regional burns units for definitive soft-tissue cover. Such individuals have complex requirements after severe sepsis, and usually have complicated wounds. We have developed a protocol for managing these patients and their wounds within a high dependency, intensive-care unit, using allograft as an adjunct in preparing the tissue bed before autografting. This protocol includes optimisation of nutritional needs, microbiological surveillance and definitive soft tissue cover. We retrospectively reviewed all children referred over 18 months for management of skin and soft tissue loss after meningitis purpura fulminans. We reviewed the initial management of the septicaemia, associated co-morbidities, site and size of soft tissue defect, time to presentation for definitive skin cover, surgical procedure performed, timing of surgical intervention, and recovery of the patient's wounds. A total of six people (all children), with a mean age of 7 months (age range 4-21 years) were admitted to our unit between March 2004 and September 2005. Total percentage skin loss was 12% (6-20%). All of the children underwent debridement, received allograft to areas of skin loss and necrosis as a primary procedure, and subsequently underwent autograft. Two children required amputation of one or more limbs, and the stumps were covered with allograft followed by skin autograft. All patients had excellent autograft skin taken using this protocol.

Original languageEnglish (US)
Pages (from-to)1520-1523
Number of pages4
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume61
Issue number12
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

Keywords

  • Allograft
  • Autograft
  • Meningococcal septicaemia
  • Purpura fulminans

ASJC Scopus subject areas

  • Surgery

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