Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome
| 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.date.updated | 2016-01-19T07:29:26Z | |
| 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.identifier.apacitation | Bickler, S., Bosenberg, A. T., Numanoglu, A., & Rode, H. (2007). Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome. <i>South African Journal of Surgery</i>, http://hdl.handle.net/11427/16428 | en_ZA |
| dc.identifier.chicagocitation | Bickler, SW, A T Bosenberg, A Numanoglu, and H Rode "Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome." <i>South African Journal of Surgery</i> (2007) http://hdl.handle.net/11427/16428 | en_ZA |
| 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.ris | TY - Journal Article AU - Bickler, SW AU - Bosenberg, A T AU - Numanoglu, A AU - Rode, H AB - 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. DA - 2007 DB - OpenUCT DP - University of Cape Town J1 - South African Journal of Surgery LK - https://open.uct.ac.za PB - University of Cape Town PY - 2007 SM - 0038-2361 T1 - Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome TI - Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome UR - http://hdl.handle.net/11427/16428 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/16428 | |
| dc.identifier.vancouvercitation | Bickler S, Bosenberg AT, Numanoglu A, Rode H. Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome. South African Journal of Surgery. 2007; http://hdl.handle.net/11427/16428. | en_ZA |
| dc.language | eng | en_ZA |
| dc.publisher | Health and Medical Publishing Group | en_ZA |
| dc.publisher.department | Department of Paediatrics and Child Health | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| 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 |
| uct.subject.keywords | Meningococcal septicaemia | en_ZA |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |