Management of purpura fulminans at the upper extremity.

Abstract

A multidisciplinary approach often is needed, especially at the acute phase. Indeed, resuscitative treatment is first indicated. [figure: see text] Optimal time for surgery depends on the patient's status. Surgical management should be more aggressive than previously thought. Debridement of necrotic tissue must be performed when the eschar has demarcated to avoid infection. Escharectomy can improve the vitality of the distal segments by releasing the compressive mechanical effect. In the same vein, early amputations are likely to reduce the need for secondary revisional surgery. Necrotic tissue over a joint should be excised early and procedures to provide coverage by flaps should be undertaken to avoid osteoarthritis. Late sequelae are dominated by skeletal growth disturbances and require specific procedures.