Pollard Rebecca L E, Kennedy Peter J, Maitz Peter K M
Burns Unit, Concord Repatriation General Hospital, Hospital Road, Sydney, 2139 NSW, Australia.
J Plast Reconstr Aesthet Surg. 2008;61(3):319-22. doi: 10.1016/j.bjps.2007.10.029. Epub 2007 Dec 19.
Meningococcal sepsis leading to purpura fulminans leaves survivors with extensive areas of skin and soft-tissue necrosis. Soft-tissue loss in the limbs may result in large areas of exposed bone, leaving a choice between free tissue transfer and amputation. We present a case of meningococcal sepsis where the entire medial and lateral surfaces of the tibiae were exposed with loss of anterior muscle compartments on each side. Faced with the possibility of bilateral above-knee amputation, these were instead covered using the dermal replacement Integra (Integra LifeSciences Corp.), in conjunction with an antimicrobial dressing, topical negative pressure dressing and subsequent skin grafting. This management decision achieved rapid wound closure avoiding amputation. Additional secondary reconstruction with microvascular free flaps was performed to preserve joint function.
