Reconstruction of Near-Total Loss of the Upper and Lower Lips due to Purpura Fulminans with Local Tissue and a Dual-Skin Paddled Anterolateral Thigh Flap

Kuwahara, Masamitsu; Yurugi, Satoshi; Yamanaka, Yuji; Sasaki, Chikako; Nakanishi, Takashi

doi:10.1097/gox.0000000000001505

Cited by 3 publications

(3 citation statements)

References 11 publications

(16 reference statements)

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“…A total of 190 patients age ≥ 15 years were diagnosed with PF and underwent a surgical procedure. There were 68 case studies [1, 6, 12–25, 27, 29, 31–40, 43–45, 47–61, 63, 65–72, 74, 75, 77–87], nine case series [8, 26, 30, 41, 42, 46, 64, 73, 76], one prospective cohort [62], and one retrospective cohort [28] studies published in English. All outcomes queried were identifiable during data extraction.…”

Section: Resultsmentioning

confidence: 99%

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Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

et al. 2019

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Background Cutaneous manifestations of purpura fulminans (PF) present many challenges for clinicians and surgeons. In a state of septic shock complicated by limb ischemia, surgical interventions are necessary to control the pathological cascade and improve patient outcomes. The objective of this article was to report etiologies and surgical outcomes associated with cutaneous manifestations in adults. Methods This systematic review and meta-analysis compared 190 adult patients with etiologies, signs and symptoms, and surgical outcomes associated with cutaneous manifestations of PF. The PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical interventions, outcomes, and complications were recorded. Results Seventy-nine studies were eligible for the systematic review, and 77 were eligible for meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. A total of 71/190 (38%) cases reported surgical debridement. Fasciotomies were reported in 12/190 (6%) cases and 20 procedures. Amputations were reported in 154/190 (81%) cases. Reconstruction was reported in 45 cases. Skin grafts were applied in 31 cases. Flaps were used for reconstruction in 28 cases. Median (IQR) surgical procedures per patient were 4 (4, 5) procedures. Infectious organisms causing PF were 32% Neisseria meningitidis (n = 55) and 32% Streptococcus pneumonia (n = 55). Coagulase-negative Staphylococcus (95% confidence interval (CI)(8.2–177.9), p = 0.032), Haemophilus influenza (95%CI (7.2–133), p = 0.029), Streptococcus pneumonia (95% CI (13.3–75.9), p = 0.006), and West Nile Virus (95%CI (8.2–177.9), p = 0.032) were associated with significantly more extensive amputations compared to other organisms. Conclusion This systematic review and patient-level meta-analysis found the most common presentation of PF was septic shock from an infectious organism. Neisseria meningitidis and Streptococcus pneumonia were equally the most common organisms associated with PF. The majority of cases were not treated in a burn center. The most common surgeries were amputations, with below-the-knee-amputations being the most common procedure. Skin grafting was the most commonly performed reconstructive procedure. The most common complications were secondary infections. Organisms with significantly more extensive amputations were coagulase-negative Staphylococcus, Haemophilus influenza, Streptococcus pneumonia, and West Nile Virus. Interpretation of findings should be cautioned due to limited sample data.

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Section: Resultsmentioning

confidence: 99%

“…Of the 79 studies included in the systematic review, 77 were included in the meta-analysis [1, 6, 8, 12–27, 29–61, 63–87]. Two studies were excluded due to inaccessibility of patient-level data to perform the quantitative synthesis.…”

Section: Resultsmentioning

confidence: 99%

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

et al. 2019

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“…The patient was a 60-year-old man with purpura fulminans, whose upper and lower lips were reconstructed with a free anterolateral thigh flap, reported previously. 3 Two years after the reconstruction, drooping of the reconstructed lower lip occurred. A piece of cartilage (thickness: 5 mm) was grafted without screw fixation.…”

Section: Patientmentioning

confidence: 99%

Costal Cartilage Graft to Prevent Drooping after Free Flap Reconstruction of the Lower Lip

Kuwahara¹,

Yurugi²,

Mashiba³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: For large lower lip defects, a thin flap combined with a tendon is the standard reconstructive option. However, this method can result in flap ptosis, which occurred in two of our patients. To correct the ptosis, we transplanted costal cartilage into the reconstructed lower lips, which produced good or moderate results. We report our experience based on long-term follow-up. In case 1, reconstruction was performed with a latissimus dorsi myocutaneous flap. Within 10 years of the first cartilage transplant, two additional surgeries were required due to cartilage/screw breakage. These problems may have been triggered by the bulkiness of the flap and/or the angle at which the cartilage was anchored in place. There have not been any further problems for 3 years. In case 2, reconstruction was performed with a free anterolateral thigh flap. The skin around the flap had poor extensibility, and the patient had marked Class II occlusion. We grafted cartilage without fixing it to the mandible. However, temporary interference with the maxillary dentition was observed. In conclusion, costal cartilage grafts are effective against flap ptosis after free flap reconstruction of the lower lip in patients without Class II occlusion. To achieve long-term stability, the optimal angle and positioning of the cartilage and the extensibility of the skin must be thoroughly investigated before surgery, and a thick piece of cartilage must be firmly fixed in place.

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Free flap for lower limb salvage in infectious purpura fulminans

Boucher¹,

Guerre²,

Duquennoy-Martinot³

et al. 2021

Annales de Chirurgie Plastique Esthétique

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Reconstruction of Near-Total Loss of the Upper and Lower Lips due to Purpura Fulminans with Local Tissue and a Dual-Skin Paddled Anterolateral Thigh Flap

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 11 publications

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

Costal Cartilage Graft to Prevent Drooping after Free Flap Reconstruction of the Lower Lip

Free flap for lower limb salvage in infectious purpura fulminans

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