Multiple Amputees: Complications of Meningococcemia/Purpura Fulminans Medical, Surgical, and Prosthetic Treatment
JAY NOGI, MD, LINDA COHEN, OTR,JILL MAYHEW, PT, AND CHESTER SHARPS, MD
During the past five years, we have treated two boys and one girl with purpura fulminans, a dreaded sequela of meningococcernia. All were younger than 2 years-old at the onset of their disease, first seen in acute cardiorespiratory collapse requiring emergency resuscitation. Each child is now a multiple amputee. None sustained permanent central nervous system defect.
Once stabilized, they underwent multiple drainage and debridement procedures to preserve upper and lower-limb viability and length. Secondary opportunistic infections were not a problem. Only one below-knee amputation was possible; four other lower limbs were converted to knee disarticulations. One lower limb sloughed only toes. All children lost fingers proximal to the proximal phalanx or metacarpal necks. Upper-limb prostheses have not been considered yet. Surgery, including metacarpal lengthening and web-space enlargement, has improved pinch. Intensive occupational therapy to prevent contractures and orthoses have benefitted the children early in their disease. Aggressive medical and surgical managment has decreased the mortality rate. Appropriate prosthetic fitting, intensive physical and occupational therapy, and thorough psychological counseling for the family have allowed the children to return home to school and play.
Children's Hospital, 2924 Brook Road, Richmond, VA 23220