The Orthopaedic Implications of Peripheral Limb Ischaemia in Infants and Children

Farrar, M. J.; Bennet, G.C.; Wilson, Neil; Azmy, Amir

doi:10.1302/0301-620x.78b6.0780930

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…It seems that, in children who survive the initial resuscitation, there is seldom the need to perform upper limb or above-knee amputations. While this study supports this hypothesis, some authors have described forearm amputation [4,13] or above-knee amputation [14].…”

Section: Discussionsupporting

confidence: 79%

Meningococcal purpura fulminans in children: I. Initial orthopedic management

Nectoux

Mezel

Raux

et al. 2010

Journal of Children's Orthopaedics

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Background Purpura fulminans is a rare and extremely severe infection, mostly due to Neisseria meningitidis frequently causing early orthopedic lesions. Few studies have reported on the initial surgical management of acute purpura fulminans. The aim of this study is to look at the predictive factors in orthopedic outcome in light of the initial surgical management in children surviving initial resuscitation. Methods Nineteen patients referred to our institution between 1987 and 2005 were taken care of at the very beginning of the purpura fulminans. All cases were retrospectively reviewed so as to collect information on the total skin necrosis, vascular insufficiency, gangrene, and total duration of vasopressive treatment.

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Section: Discussionsupporting

confidence: 79%

Meningococcal purpura fulminans in children: I. Initial orthopedic management

Nectoux

Mezel

Raux

et al. 2010

Journal of Children's Orthopaedics

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“…A study from the Royal Hospital of Sick Children in Glasgow identified 12 children treated by the orthopedic department between 1977 and 1992 for limb ischemia with or without gangrene. 2 In that series, nine were neonates. All 12 cases were treated conservatively, and no surgery was undertaken until a line of demarcation had been well established.…”

Section: Discussionmentioning

confidence: 90%

“…This algorithm includes invasive options but as the review by Farrar et al showed, the results following conservative management are devastating. 2 Because of the continued improvement in microsurgical techniques, we believe that surgical treatment options should be considered in the neonate and that the sizes of the vessels are no longer a contraindication.…”

Section: Angiogrammentioning

confidence: 99%

Idiopathic Neonatal Ischemia in the Upper Limb: The Role of the Microsurgeon

Zetlitz

Weiler-Mithoff²,

Turner³

2008

Amer J Perinatol

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Idiopathic neonatal limb ischemia remains a rare occurrence. It is a devastating process that leads to complete or partial loss of affected limb or severe deformity. The main treatments over the years have been conservative and nonsurgical, such thrombolysis. Surgical treatment has traditionally been delayed until a line of demarcation is clear, at which time amputation of the limb proceeds. We present a case of idiopathic upper limb ischemia in a newborn, where it was clear that nonsurgical management would result in limb necrosis. A thrombus extended from the brachial bifurcation into both ulnar and radial arteries to the wrist. The plastic surgery team performed surgical decompression and microsurgical open thrombectomy to successfully reestablish the circulation to the affected hand. Eight months later, the child remains well. This is the first reported case in the literature where an idiopathic thrombus blocking the brachial, radial, and ulnar arteries is successfully treated microsurgically.

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“…Secondary operations of the amputation stumps, grafts, and scar correction may be necessary [21]. In cases of asymmetric bone growth resections must be done [5,7].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, below this age the risk of PF is greatest. The clinical picture and dramatic evolution of some of these cases are described in publications of a large variety of medical specialities [1,2,4,7,8,9,24]. Bacteria are most frequently involved (Neisseria meningitidis, Haemophilus influenzae, Streptococcus b-haemolyticus, Pseudomonas aeruginosa), as are viruses (Varicella zoster).…”

Section: Introductionmentioning

confidence: 99%

Mutilations due to medical disorders in children

2003

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Soft-tissue and bone necrosis, although rare in childhood, occasionally occur in the course of infectious diseases, either viral or bacterial, and seem to be the result of hypoperfusion on a background of disseminated intravascular coagulation. Treatment consists in correction of septic shock and control of necrosis. Necrosis, once started, shows extraordinarily rapid evolution, leading to soft-tissue and bone destruction and resulting in anatomic, functional, psychological, and social handicaps. Ten mutilated children were treated from January 1986 to January 1999 in Hospital de Dona Estefaˆnia, Lisbon, Portugal. One was recovering from hemolytic-uremic syndrome with a severe combined immunodeficiency, another malnourished, anemic child had malaria, and three had chicken pox (in one case complicated by meningococcal septicemia). There were three cases of meningococcal and two of pyocyanic septicemia (one in a burned child and one in a patient with infectious mononucleosis). The lower limbs (knee, leg, foot) were involved in five cases, the face (ear, nose, lip) in four, the perineum in three, the pelvis (inguinal region, iliac crest) in two, the axilla in one, and the upper limb (radius, hand) in two. Primary prevention is based on early recognition of risk factors and timely correction. Secondary prevention consists of immediate etiologic and thrombolytic treatment to restrict the area of necrosis. Tertiary prevention relies on adequate rehabilitation with physiotherapy and secondary operations to obtain the best possible functional and esthetic result.

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The Orthopaedic Implications of Peripheral Limb Ischaemia in Infants and Children

Cited by 8 publications

References 11 publications

Meningococcal purpura fulminans in children: I. Initial orthopedic management

Meningococcal purpura fulminans in children: I. Initial orthopedic management

Idiopathic Neonatal Ischemia in the Upper Limb: The Role of the Microsurgeon

Mutilations due to medical disorders in children

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