Delayed Surgical Debridement and Use of Semiocclusive Dressings for Salvage of Fingers After Purpura Fulminans

Abstract

Background: Purpura fulminans is a condition characterized by rapidly evolving skin necrosis and disseminated intravascular coagulation. Early recognition and aggressive supportive management has led to a decrease in its mortality rate, but most of these patients must undergo extensive soft tissue debridement and partial or total limb amputation. There is controversial evidence about the timing of surgery, suggesting that some patients may benefit from delayed debridement with limb preservation. Methods: We present a case of an 86-year-old patient who developed skin necrosis of his four limbs after infectious purpura fulminans. He was treated in the ICU with supportive measures and antibiotic treatment. Surgical debridement was delayed for 4 weeks until necrosis delimitation. Results: Only upper extremity debridement was necessary. Four fingers, including one thumb, were salvaged and successfully treated with semi-occlusive dressing without complications. Conclusion: Early recognition of infectious PF and timely supportive management are important pillars of its treatment. Delayed surgical debridement allows for less aggressive resection and good functional outcome.

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

“…The 79 studies included in the systematic review were published from 1968 through 2019 (see Additional file 2: Table S1 and Additional file 3: Table S2) [1, 6, 8, 12–87]. The numbers of studies published per decade were one, 1960 to 1969; zero, 1970 to 1979; two, 1980 to 1989; six, 1990 to 1999; 23, 2000 to 2009; and 47, 2010 to 2019 (Fig.…”

“…A total of 190 patients age ≥ 15 years were diagnosed with PF and underwent a surgical procedure. There were 68 case studies [1, 6, 12–25, 27, 29, 31–40, 43–45, 47–61, 63, 65–72, 74, 75, 77–87], nine case series [8, 26, 30, 41, 42, 46, 64, 73, 76], one prospective cohort [62], and one retrospective cohort [28] studies published in English. All outcomes queried were identifiable during data extraction.…”

“…Of the 79 studies included in the systematic review, 77 were included in the meta-analysis [1, 6, 8, 12–27, 29–61, 63–87]. Two studies were excluded due to inaccessibility of patient-level data to perform the quantitative synthesis.…”

“…Although first described in 1884 by Guelliot in children suffering from bacterial and viral infections, most children who developed PF have inherited deficiencies in protein C [2, 4]. This rare disorder presents in adults most commonly as an acute complication due to an abnormal response to systemic infections [5, 6]. Neisseria meningitis and Streptococcus pneumonia septicemia have been reported as an etiology in as many as 25% of children; however, data for adults is unknown [2, 7].…”

Four Extremity Amputation and Bionic Prosthesis Supply after Disseminated Intravascular Coagulation: A Follow-Up on Functionality and Quality of Life after Bionic Prosthesis Supply

“…The necrectomy of the avital tissue and the amputation of acral necrosis after demarcation is necessary in DIC as well as in PF. 7…”