Burns 24 (1998) 272-274 Surgica.1 treatment of extensive skin necrosis secondary to purpura lminans in a patient with meningococcal sepsis J. M. Ariivalo”“, J. A. Lorente”, Raid Fonsecaa “Sewicio de Cirugia Plbsticu y Unidad de Grandes Qnemados, Hospital Universitario de Getafe, Carretera de Toledo Karl 12,500 Madrid 28905, Spain hUnidad de C&ados Intensives, Hospital Universitario de Getafe, Carretera de Toledo h’m 12,500, Madrid 28YO5, Spain Accepted 10 October 1997 Abstract Meningococcal sepsis is associated with a high mortality rate. These patients may show severe disseminated intravascular coagulation (DIC) and skin necrosis. There is very little published experience regarding the surgical treatment of this complica- tion. The similau-ity between skin necrosis secondary to DIC and full thickness cutaneouos burns provides the rationale for its treatment as if it wasa deep burn. We report the surgical treatment of extensive skin necrosis in a patient with meningococcal sepsis and DIC. This treatment is similar to that used in full thickness burns, including excision of necrotic tissue and coverage with autografts, aswell asamputation of extremities if distal coverageis not possible. 0 1998Elsevier Science Ltd for ISBI. All rights reserved. Keywords: Skin necrosis; Meningococcal sepsis; Amputation; Flap 1. Introduction Meningococcal sepsis is associated with a high mortality rate. These patients typically show severe disseminated intravascular coagulation (DIC) and skin necrosis. There is very little published experiencle regarding the surgical treatment of this complication. The similarity between skin necrosis secondary to DIC and full-thickness cutaneous burns provides th’e rationale for treatment as if they were deep burns. We recently had the opportunity to treat a patient with meningococcal sepsisand extensive skin necrosis using this approach. We here report our experience. 2. Case report A 21-year-old male was admitted because of fever and a purpuric ecchymotic progressive skin rash during the previous 24 h. There was no meningeal signs. Laboratory tests revealed renal failure and severe coagulopathy (PT 32 per cent, APTT 72’, D dimer 300 ,ug/dl, fibrinog,en 145 mg/dl, platelet count 90 OOO/pl, crieatinine 2.8 mg/dl). Blood cultures grew N. meningi- tidis (serotype C). During his stay in the ICU, had ventilator-associated pneumonia, and suffered a subar- achnoid haemorrhage, shock, and extensive skin necrosis in the lower and upper extremities (45 per cent body surface area). The clinical course was favour- able with ceftriaxone i.v. and intensive care support, and organ dysfunction resolved. When the general condition of the patient improved, the patient under- went a series of seven operations, in which tangential excision of the necrotic skin areas was performed. Owing to the impossibility to perform distal coverage, amputation of both lower limbs and distal phalanx of fingers 2-5 of the right hand was required. The left patella was covered with an internal saphenous island flap. Other areas were covered with autografts when an adequate granulation tissue was obtained after excis- sion. Due to the appearance of clinical signs of infec- tion, the right lower limb required reamputation at a higher level. The patient was discharged after 43 days in the ICU. 3. Discussion *Col7ssponding author: Dr J. M. Artvalo, Hospital Uni. de Getafe, Servicio de Girugia Plastica y, Unidad de Grandes Quemados, Carrelera de Toledo Km 12,500. 28905 Madrid, Spain. Infection by IV meningitidus strikes all age groups, particularly between one month and 4 years of age. 0305.4179/98/%19.00 + 0.00 0 1998 Elsevier Science Ltd for ISBI. All rights reserved. PII: SO305-4179(97)00120-4