Purporse:Acute infectious purpura fulminans (AIPF) is a complication of severe sepsis. Devastating soft tissue injury is the rule. Survival rates in severe sepsis are improving, in part due to the introduction of activated recombinant protein C (drotecrogin alfa). However, to date, there is no consensus on its effect on soft tissue morbidity.
Methods:A retrospective review of the charts of three consecutive cases of AIPF seen over an eight month period was done. Meningococcemia and pneumococcemia were diagnosed in two patients, the third had negative cultures. APACHE II scores predicted mortality of 56-73%. Drotecrogin alfa was started by an average of 27.3 hours at 24mcg/kg/hr for 96 hours.
Results:All patients survived. All required major limb amputation. One required a groin flap for hand reconstruction, and another required 650cm2 of skin grafting.
Conclusions:In this series, drotecrogin alfa did not improve amputation rates over expected rates (19-100%). This may be a function of timing of administration. Additionally, extremitiy compartment pressures were not measured. It is suggested that fasciotomy may reduce major limb morbidity. Clearly, controlled trials are necessary to determine the effect of drotecrogin alfa on soft tissue morbidity. Early involvement of the plastic surgeon in the care of these patients is prudent.