Amputation Resulting from Septic Shock: Case Studies


Amputation resulting from septic shock presents numerous challenges to the medical team. Because of extensive necrosis it is not always possible to salvage the limb at the usual and preferable optimal functional level. Underlying bony deformities in the amputated and non-amputated extremity may also affect prosthetic usage and fit. Necrotic skin may require plastic surgery and also cause problems in stump maintenance and prosthetic tolerance.

Septic shock most commonly occurs as a result of bacterial infection. Bacteria associated with septic shock include meningococcus, pneumococcus, and H. influenza, among others. Various viruses are also known to cause septic shock.

Forty children were admitted to our facility with septic shock resulting from bacterial infection from 1985 to 1990. 5%, or two patients died. 20%, or eight patients required surgical intervention. Of these eight, six patients required single or multiple amputations.

Our patients demonstrated no consistent pattern of amputation. Two children required unilateral above-knee amputation, one lost multiple fingers and toes, one child required bilateral below-knee amputation, one child required bilateral above-knee and unilateral above elbow amputation, and one child required bilateral above-knee and unilateral below-elbow amputation.

Special problems of prosthetic fitting and tolerance seen in this group of patients will be presented.

Children's Hospital, Oakland, 747 52nd Street, Oakland, CA 94609