Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome

 

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dc.contributor.author Bickler, SW
dc.contributor.author Bosenberg, A T
dc.contributor.author Numanoglu, A
dc.contributor.author Rode, H
dc.date.accessioned 2016-01-19T11:50:27Z
dc.date.available 2016-01-19T11:50:27Z
dc.date.issued 2007
dc.identifier.citation Numanoglu, A., Bickler, S. W., Rode, H., & Bosenberg, A. T. (2007). Meningococcal septicaemia complications involving skin and underlying deeper tissues-management considerations and outcome: paediatric surgery. South African Journal of Surgery, 45(4), 142-146. en_ZA
dc.identifier.issn 0038-2361 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/16428
dc.description.abstract Objective: To describe surgical experience with purpura fulminans related to meningococcaemia in a single institution, and to suggest a management protocol. Methods: A retrospective review was done of patients admitted to the intensive care unit at Red Cross War Memorial Children's Hospital in Cape Town with the clinical diagnosis of purpura fulminans. Results: During a 28-year period (1977 - 2005) 112 children (average age 3.4 years) were treated for meningococcaemia with purpura fulminans. Overall mortality was 10.7%. Local treatment consisted of measures to improve circulation, infection control and healing of necrotic tissue. Demarcation of necrotic areas was evident at 5.5 days and the average area of skin necrosis was 14% total body surface area (range 2 - 85%). The lower limbs were predominantly affected. Purpura fulminans resolved in 35 children (31.2%) without skin necrosis. Skin grafting was required in 77 children (68.8%). Factors associated with a poor outcome for peripheral extremity salvage were progressive irreversible skin changes, early disappearance of distal pulses, tense cold swollen extremities and intense pain on passive movement of the affected extremity. Amputations were performed proximal to the area of necrosis, on average 27 days after injury. Conclusions: Meningococcaemia is a disease with potentially devastating consequences. Early surgical consultation is essential. Skin- and soft-tissue-releasing incisions should be considered early to reduce the incidence of extremity necrosis. Small necrotic areas usually separate spontaneously with secondary healing or can be excised and sutured. Larger necrotic areas should be excised only after demarcation has been established, and can be covered with delayed skin grafting. Amputation should be conservative but may require revision. en_ZA
dc.language eng en_ZA
dc.publisher Health and Medical Publishing Group en_ZA
dc.source South African Journal of Surgery en_ZA
dc.source.uri http://www.sajs.org.za/index.php/sajs
dc.title Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome en_ZA
dc.type Journal Article en_ZA
dc.date.updated 2016-01-19T07:29:26Z
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
uct.subject.keywords Meningococcal septicaemia en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Paediatrics and Child Health en_ZA
uct.type.filetype Text
uct.type.filetype Image


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