Case report| Volume 65, ISSUE 2, P252-255, February 2012

Nose and upper lip reconstruction for purpura fulminans



      Purpura fulminans (PF) is a rare syndrome of intravascular thrombosis and haemorrhagic infarction of the skin. The initial symptom of PF is peripheral purpura which progresses to necrosis very rapidly. The prognosis of PF is poor, and the mortality is reported to be around 40%. Even if the patient survives, the patient may require amputation or reconstruction for limbs and facial necrosis.

      Case report

      A 48-year-old male suffered from PF following a left cerebellopontine angle tumour excision. His nose and upper lip fell into necrosis afterwards. We performed nose and upper lip reconstruction at 8 months after the onset. We used a forehead flap for the nasal reconstruction and a free forearm flap for the lining. His upper lip was reconstructed with bilateral nasolabial orbicularis oris myocutaneous flaps.


      The colour and texture match of the reconstructed nose and lip is good. He could open his mouth wide enough and close completely.


      Facial reconstruction after PF is very difficult, because the patient has extensive scarring around the defect and there is little intact facial tissue. However, we performed a facial reconstruction using local flaps as much as possible, and obtained good results.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Edlich R.F.
        • Cross C.L.
        • Dahlstrom J.J.
        • Long III, W.B.
        Modern concepts of the diagnosis and treatment of purpura fulminans.
        J Environ Pathol Toxicol Oncol. 2008; 27: 191-196
        • Childers B.J.
        • Cobanov B.
        Acute infectious purpura fulminans: a 15-year retrospective review of 28 consecutive cases.
        Am Surg. 2003; 69: 86-90
        • Har-El G.
        • Nash M.
        • Chin N.W.
        • Meltzer C.J.
        • Weiss M.H.
        Purpura fulminans of the head and neck.
        Otolaryngol Head Neck Surg. 1990; 103: 660-663
        • Henoch E.
        Ueber purpura fulminans.
        Am J Med Wochnschr. 1886; 11: 494
        • Olowu W.A.
        Klebsiella-induced purpura fulminans in a Nigerian child: case report and a review of literature.
        West Afr J Med. 2002; 21: 252-255
        • Arévalo J.M.
        • Lorente J.A.
        • Fonseca R.
        Surgical treatment of extensive skin necrosis secondary to purpura fulminans in a patient with meningococcal sepsis.
        Burns. 1998; 24: 272-274
        • Andreasen T.J.
        • Green S.D.
        • Childers B.J.
        Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans.
        Plast Reconstr Surg. 2001; 107: 1025-1035
        • Johansen K.
        • Hansen Jr., S.T.
        Symmetrical peripheral gangrene (purpura fulminans) complicating pneumococcal sepsis.
        Am J Surg. 1993; 165: 642-645
        • Yotsuyanagi T.
        • Yokoi K.
        • Urushidate S.
        • Sawada Y.
        Functional and aesthetic reconstruction using a nasolabial orbicularis oris myocutaneous flap for large defects of the upper lip.
        Plast Reconstr Surg. 1998; 101: 1624-1629
        • Duteille F.
        • Thibault F.
        • Perrot P.
        • Renard B.
        • Pannier M.
        Salvaging limbs in cases of severe purpura fulminans: advantages of free flaps.
        Plast Reconstr Surg. 2006; 118: 681-685