Amputation following meningococcemia. A sequela to purpura fulminans.

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.