Management of patients with Purpura Fulminans and four-limb amputation in a Burns Unit

Ania Smialkowski1 MD; Peter Kennedy2, OAM, MD, FRCS, FRACS; Peter Haertsch3, OAM, MD, FRCS, FRACS’ Peter Maitz4  OAM, MD, FRACS,

1 Concord Repatriation General Hospital Burns Unit, Level 7, Hospital Rd Concord NSW 2139; aniasmialkowski@yahoo.com.au
2 Concord Repatriation General Hospital Burns Unit, Level 7, Hospital Rd Concord NSW 2139; lis04060@izone.net.au
3 Concord Repatriation General Hospital Burns Unit, Level 7, Hospital Rd Concord NSW 2139; peter.haertsch@sswahs.nsw.gov.au
4 Concord Repatriation General Hospital Burns Unit, Level 7, Hospital Rd Concord NSW 2139; peter.maitz@sydney.edu.au

Purpura Fulminans is a rare but often fatal complication of severe sepsis, associated with the rapid development of disseminated intravascular coagulation and areas of hemorrhagic necrosis of the skin and underlying soft tissue. The treatment of Purpura Fulminans requires a multi-disciplinary team approach, similar to the needs of patients with critical burns. Early intervention, including aggressive debridement of devitalized skin and soft tissue and salvage amputation is often necessary for survival. These patients are therefore often referred to specialist burns units for different methods of soft tissue coverage and management of the wound burden and sepsis. One of the many challenges presented by this disease is balancing the level of amputation for preservation of limb function and adequate resection of necrotic tissue. This requires multiple surgical procedures for treatment of skin loss, wound breakdown, amputation revisions and reconstruction of complex defects in survivors.

Here, we present a case series of three patients with Purpura Fulminans and four-limb amputation, with overlapping admissions in our Burns Unit. A discussion of this unique series of patients is presented, highlighting their clinical presentation, management and reconstructive challenges.

Key Words

Purpura Fulminans, limb amputation, septicemia, multidisciplinary care, reconstruction

Biography

Ania Smialkowski is an Unaccredited Plastic and Reconstructive Surgery trainee in Sydney, recently working at the Concord Hospital Burns Unit.

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