Abstract
Fulminant meningococcemia can have life-threatening as well as limb-threatening complications. However, unlike other types of peripheral gangrene, areas of necrosis do not follow known anatomic vascular patterns. Instead, irregular and patchy areas of necrosis are found to exist adjacent to viable tissues. With improved critical care, more patients survive the initial insult and are referred for reconstructive procedures. In this case, a 6-year boy was diagnosed with meningococcemia-induced purpura fulminans. After stabilization, he was transferred to our facility for management of open wounds of both lower extremities and the left elbow. Soft-tissue coverage was accomplished after multiple debridements using various flaps. In particular, a defect of the right midtibia was reconstructed using a posterior tibial artery perforator-based flap with excellent results. This is the first time such a flap has been reported in association with meningococcemia in a patient of this age.
References
Potokar TS, Oliver DW, Ross-Russell R, Hall PN (2000) Meningococcal septicemia and plastic surgery—a strategy for management. Br J Plast Surg 53:142–148
Huang DB, Price M, Pokorny J, Gabriel KR, Lynch R, Paletta CE (1999) Reconstructive surgery in children after meningococcal purpura fulminans. J Pediatr Surg 34:595–601
Genoff MC, Hoffer MM, Achauer B, Formosa P (1992) Extremity amputations in meningococcemia-induced purpura fulminans. Plast Reconstr Surg 89:878–881
Herrera R, Hobar PC, Ginsburg CM (1995) Surgical intervention for the complications of meningococcal-induced purpura fulminans. Pediatr Infect Dis J 154:472–474
Wheeler JS, Anderson BJ, De Chalain TMB (2003) Surgical interventions in children with meningococcal purpura fulminans—a review of 117 procedures in 21 children. J Pediatr Surg 38:597–603
Hogan MJ, Long FR, Coley BD (1998) Preamputation MR imaging in meningococcemia and comparison to conventional arteriography. Pediatr Radiol 28:426–428
Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648
Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inouse T, Ikeda A (1992) The vasculature and clinical application of the posterior tibial artery perforator-based flap. Plast Reconstr Surg 90:643–649
Hung LK, Lao J, Ho PC (1996) Free posterior tibial perforator flap: anatomy and a report of 6 cases. Microsurgery 17:503–511
Kroll SS, Sharma S, Koutz C (2001) Postoperative morphine requirements of free TRAM and DIEP flaps. Plast Reconstr Surg 107:338–341
Gill PS, Hunt JP, Guerra AB, Dellacroce FJ, Sullivan SK, Boraski J, Metzinger SE, Dupin CL, Allen RJ (2004) A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 113:1158–1160
Masquelet AC, Gilbert A (2001) An atlas of flaps of the musculoskeletal system. Blackwell Science, Malden, pp 135–226
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Guerra, A.B. Soft-tissue reconstruction after meningococcal septicemia using a posterior tibial artery perforator flap in a 6-year-old boy. Ped Surgery Int 21, 466–469 (2005). https://doi.org/10.1007/s00383-005-1427-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-005-1427-4