The management of skin infarction after meningococcal children septicaemia in

SUMMARY. The clinical course and management of 21 children (12 females, 9 males; mean age 2.4 years) with skin necrosis secondary to meningococcal septicaemia is described. Skin necrosis was most commonly sited in the lower limbs (20 patients). Sixteen patients had multiple areas of involvement and amputation of the digits was required in 5 patients. One required an above knee amputation. Small areas of skin necrosis were managed conservatively (4 patients) but larger areas required debridement and grafting. Skin grafting was delayed in 15 patients and graft loss occurred in 8. Multiple grafting procedures were required in 6 patients. Scar revision was required in 6 patients. Nutritional support is also an important component of management. Although meningococcal infections are common in children, only 1 in 100,000 in the United States of America develops a significant illness (Gold and Joye, 1987; Behrman and Vaughan, 1987). When this occurs two clinical patterns can emerge. In the majority of cases, meningitis occurs without septicaemic shock. However, lO-20% of patients develop a fulminant septicaemia characterised by endotoxic shock, disseminated intravascular coagulopathy and haemorrhagic skin lesions which progress to skin infarction (Toews and Bass, 1974; Adendorff et al., 1980). It is this latter group which is associated with a significant mortality that has not decreased over the past 30 years despite early treatment (Gold and Joye, 1987). Meningococcal infections are endemic to the Western Cape of South Africa, occurring at an incidence of 20/ 100,000 population which is 4-5 times higher than the rest of South Africa. The reason for this is not clear. This study reports the clinical manifestations and management of this disease in a major referral hospital over a 15-year period. Materials and methods The records of all patients with skin necrosis secondary to meningococcal septicaemia presenting to Red Cross Children’s Hospital between 1977 and 1991 were reviewed. During this period 21 children were seen. There were 12 females and 9 males with an average age of 2.4 years (range 5 months to 6 years). Patients were only referred to the plastic surgery department after management of the acute septicaemic/endotoxic shock in the paediatric intensive care unit. While in this unit the skin lesions were treated with daily povidone iodine dressings. Once the septicaemia had resolved and the children were clinically stable, they were transferred to the plastic surgery department for