Griffith G L, Luce E A
South Med J. 1978 Nov;71(11):1337-40. doi: 10.1097/00007611-197811000-00007.
The occurrence of massive skin necrosis of approximately 50% of the body surface area in an 8-year-old girl with Rocky Mountain spotted fever is reported. Although the surgeon will not often be confronted with the management of Rocky Mountain spotted fever or its complications, certain therapeutic corollaries can be outlined, based upon the observed similarity between this particular complication of severe skin loss and the syndrome of purpura fulminans: (1) heparinization for the consumptive coagulopathy and disseminated intravascular clotting; (2) correction of hypovolemia and hypoproteinemia; (3) decompression by escharotomy and/or fasciotomy if indicated; (4) topical chemotherapeutic coverage of necrotic skin; (5) full-thickness eschar excision combined with biologic dressings directed toward autograft wound closure; and (6) appropriate extremity splinting and physiotherapy.
报告了一名8岁患落基山斑疹热的女孩出现约50%体表面积的大面积皮肤坏死。尽管外科医生并不常遇到落基山斑疹热或其并发症的处理，但基于观察到的这种严重皮肤缺失的特殊并发症与暴发性紫癜综合征之间的相似性，可以概述某些治疗推论：（1）针对消耗性凝血病和弥散性血管内凝血进行肝素化治疗；（2）纠正血容量不足和低蛋白血症；（3）如有指征，通过焦痂切开术和/或筋膜切开术进行减压；（4）对坏死皮肤进行局部化疗覆盖；（5）全层焦痂切除并结合生物敷料以实现自体移植伤口闭合；以及（6）适当的肢体夹板固定和物理治疗。
