The Correction of Severe Growth Abnormalities Following Purpura Fulminans Using the Ilizarov Technique


Purpura fulminans is a destructive complication of sepsis causing ischemia of skin, soft tissue, and bone. Amputation has often been required to treat acute gangrene and in the reconstructive phase for prosthesis application. The poor quality of skin over the stumps and overgrowth of the extremities has complicated treatment. Better acute treatment of purpura fulminans, followed by aggressive debridement and skin coverage has helped children to retain their limbs only to have them deform with growth.

The Ilizarov techniques affords the unique ability to correct these severe angular deformities, as well as to lengthen the affected limb segment which may have little growth potential. Two cases are presented which demonstrate the principles of angular correction and lengthening of multiple extremities after severe purpura fulminans. Both had similar presentations in the lower extremities with severe varus deformities of both tibia due to physeal arrest, fibular overgrowth and multiply graft skin. Furthermore, both children had distal femoral growth arrest as well as variable upper extremity involvement. Six limb segments were treated with maximum angular correction of 65° and limb segment lengthening of 55%. No soft tissue problems were encountered. Complications included minor pin tract infections, premature consolidation and transient knee flexion contractures.

We feel this technique offers a true advantage to those patients with severe deformity and significant actual or potential limb shortening.

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