Salvage of complex knee wounds in bilateral lower limb amputees as a consequence of Purpura Fulminans: A reconstructive challenge for the burns surgeon

Ania Smialkowski1 MD; Andrea Issler-Fisher2, MD; 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;  andrea.isslerfisher@gmail.com
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 (PF) is a devastating sequelae of life threatening sepsis characterized by rapid onset of hemorrhagic necrosis of the skin and underlying soft tissue. These patients are often treated in a Burns Unit because of the degree of skin and soft tissue loss and need for different methods of definitive coverage. As more patients are surviving the disease due to aggressive and early management, reconstructive surgeons are presented with multiple and complicated wounds as a sequelae of the disease.

Various reconstructive methods have been described for coverage of soft tissue defects around the knee. Coverage of exposed joints in patients with Purpura Fulminans and bilateral lower limb amputation poses a challenging problem. Many of the traditional workhorse flaps are not available due to extensive surrounding tissue necrosis affecting local and regional donor sites. Free tissue transfer has been described however this is also unreliable due to the unknown extent of microvascular injury in recipient vessels within the zone of injury.

Here we present two complex patients with Purpura Fulminans with bilateral lower limb amputation and exposed patella/knee joint treated at Concord Hospital Burns Unit. The reconstructive challenges are discussed. We felt that salvaging the patella and preserving a functional knee joint was important to the rehabilitation potential of these patients. Both patients underwent multiple attempts at reconstructing the defects.

Key Words

Purpura Fulminans, complex knee wounds, reconstruction, exposed knee joint

Biography

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

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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