Boeckx Willy D, Nanhekhan Lloyd, Vos Gijs D, Leroy Piet, Van den Kerckhove Eric
Department of Plastic Surgery, ULB Brussels University Hospital, Brussels, Belgium.
J Pediatr Surg. 2009 Aug;44(8):1625-30. doi: 10.1016/j.jpedsurg.2007.12.060.
Surgical treatment of children with meningococcal sepsis has mainly involved debridement of necrotic skin and amputation of limbs. This resulted in major functional impairment. On the contrary, when early microsurgical arteriolysis was performed, freeing up the blood vessels, the impaired blood flow could be restored, thereby significantly reducing the amputation levels.
We prospectively evaluated 14 patients affected by meningococcal sepsis. In 7 patients, microsurgical arteriolysis was performed; standard sepsis treatment was performed on the remaining 7. Ischemia levels on admission were compared with permanent amputation levels after 1 year.
Statistically significant decreases (P = .005) in ischemia values were achieved by the arteriolysis, in comparison with final amputation percentages. The functional impairment of the affected limbs was highly reduced compared with the probable loss of function observed on admission.
Our findings show that early microsurgical arteriolysis is a reliable method to reduce the devastating amputations normally found in patients with meningococcal sepsis. This significantly improves the functional outcome in severely ischemic limbs in meningococcal induced septic children.
脑膜炎球菌败血症患儿的外科治疗主要包括坏死皮肤清创术和肢体截肢术。这导致了严重的功能障碍。相反，当早期进行显微外科动脉松解术，使血管得以疏通时，受损的血流可以恢复，从而显著降低截肢水平。
我们前瞻性评估了14例脑膜炎球菌败血症患儿。其中7例患儿接受了显微外科动脉松解术；其余7例接受标准败血症治疗。比较入院时的缺血水平与1年后的永久性截肢水平。
与最终截肢百分比相比，动脉松解术使缺血值有统计学意义的显著降低（P = 0.005）。与入院时可能出现的功能丧失相比，患肢的功能障碍程度大幅降低。
我们的研究结果表明，早期显微外科动脉松解术是一种可靠的方法，可减少脑膜炎球菌败血症患者通常出现的毁灭性截肢情况。这显著改善了脑膜炎球菌感染败血症患儿严重缺血肢体的功能结局。
