Purpura fulminans associated with meningococcemia is a devastating disease in children. The tissue loss can be extensive and difficult to determine at the outset. Many children survive the disease but suffer major morbidities such as amputation. The authors suggest a strategy to manage these wounds with the goal of preserving as much tissue and function as possible. At the present time, conservative therapy to the wounds appears to be the best course in the initial, critical phase, as long as no active local purulence is found. Debridement or amputation is performed when the nonviable tissue margins are delineated. Temporary coverage with allograft may be required, and definitive coverage is accomplished when the local tissue perfusion has recovered. Future revisions are often necessary and should be pursued aggressively to improve these children's quality of life.
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