Infections
Infectious emboli from meningococcemia may autoamputate limbs or digits (62). The process frequently involves all four limbs. Growth plates may be affected, resulting in angular deformity and the need for surgical epiphysiodesis (63).
Frequently, the skin is affected as well as the limb (64). Multiple surgical skin grafts limit the prosthetic fitting; a coordinated burn team is often best prepared to handle initial management (65). Over the past few decades, the incidence of invasive meningococcal disease in the United States has remained relatively stable (66-68). Pneumococcal septicemia also can produce purpura fulminans, characterized by acute onset of rapidly progressive hemorrhagic necrosis of the skin and thrombosis (28). An example of the distal and multiple amputations caused by emboli from infections are seen in Figure 13.4.
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