Jacobsen S T, Crawford A H
Clin Orthop Relat Res. 1984 May(185):214-9.
In five patients with purpura fulminans following meningitis, gangrene of the extremities developed. Four patients required amputations of the lower extremities and two patients of the upper extremities. The gangrene is caused by disseminated intravascular coagulation. In two patients epiphyseal damage and subsequent angular deformities developed. The orthopedic surgeon should be consulted early because aponeurectomy may save an extremity. Some method of temporary skin coverage should be considered at the time of initial debridement and aponeurectomy. Early skin grafts are frequently rejected because the extent of necrosis has not declared itself, necessitating further grafting, which results in multiple painful and unsightly donor scars. Stump problems due to less than satisfactory skin coverage, stump overgrowth, joint contractures, and epiphyseal damage are later complications.
在5例脑膜炎后发生暴发性紫癜的患者中，出现了肢体坏疽。4例患者需要截肢下肢，2例患者需要截肢上肢。坏疽是由弥散性血管内凝血引起的。2例患者发生骨骺损伤并随后出现角状畸形。应尽早咨询骨科医生，因为筋膜切除术可能挽救肢体。在初次清创和筋膜切除术时应考虑某种临时皮肤覆盖方法。早期植皮常被排斥，因为坏死范围尚未明确，需要进一步植皮，这会导致多处疼痛且难看的供体瘢痕。由于皮肤覆盖不令人满意、残端过度生长、关节挛缩和骨骺损伤导致的残端问题是后期并发症。
