Roughton Michelle C, Agarwal Shailesh, Gottlieb Lawrence J
Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Illinois, USA.
J Burn Care Res. 2011 Mar-Apr;32(2):231-6. doi: 10.1097/BCR.0b013e31820aaef1.
Purpura fulminans is a syndrome characterized by hemorrhagic infarction of the skin and underlying soft tissue as a result of disseminated intravascular coagulation and intravascular thrombosis. In this study, the authors report their experience with surgical intervention for acute infectious purpura fulminans (AIPF). A retrospective chart review was performed including all patients diagnosed with AIPF from January 1, 2006, to December 31, 2008, and treated at an academic medical center. Primary endpoints of interest were overall survival rate and the need for and level of eventual amputation. Improvement in limb perfusion was included as a secondary endpoint. Nine patients were diagnosed with AIPF at the authors' institution during a 3-year period, and seven of these diagnoses were made within 12 months. Overall mortality was 44% (5/9). Amputation was required in 80% of survivors (4/5). All patients explored within 24 hours of diagnosis had evidence for compartment syndrome with visible bulging muscle on fascial release. AIPF is a devastating disease with significant mortality and morbidity primarily related to the loss of multiple limbs. This study suggests that early diagnosis and surgical intervention in the form of compartment release and sympathectomy should be performed concurrently with the initial treatment of sepsis to minimize amputations in surviving patients.
暴发性紫癜是一种由于弥散性血管内凝血和血管内血栓形成导致皮肤及皮下软组织出血性梗死的综合征。在本研究中，作者报告了他们对急性感染性暴发性紫癜（AIPF）进行手术干预的经验。对2006年1月1日至2008年12月31日期间在一家学术医疗中心接受治疗的所有诊断为AIPF的患者进行了回顾性病历审查。主要关注的终点是总生存率以及最终截肢的必要性和程度。肢体灌注的改善作为次要终点。在3年期间，作者所在机构有9例患者被诊断为AIPF，其中7例诊断在12个月内作出。总死亡率为44%（5/9）。80%的幸存者（4/5）需要截肢。所有在诊断后24小时内接受探查的患者均有骨筋膜室综合征的证据，在筋膜切开时可见肌肉膨出。AIPF是一种具有严重死亡率和发病率的毁灭性疾病，主要与多肢体缺失有关。本研究表明，应在脓毒症初始治疗的同时，早期诊断并以骨筋膜室切开减压术和交感神经切除术的形式进行手术干预，以尽量减少存活患者的截肢。
