ABSTRACT
Microsurgical nerve lengthening was performed in two siblings presenting a popliteal pterigium syndrome with a knee flexion contracture of 80 degrees. After the first attempt for nerve lengthening and knee extension elsewhere, a repeated lengthening was required due to continuing tip-toe walking and recurrent knee contracture at the age of 3 years. An extensive external and internal interfascicular microsurgical neurolysis resulted in a lengthening of the nerves. A full length of leg procedure had to be performed, inclusive of Achilles tendon lengthening to obtain a complete extension of the knee and a 90-degree ankle flexion. Maintaining the leg in a fully extended position was obtained with a dynamic splinting in the first month after the operation. When timing the operation we have to consider the importance of adequate precision of the microsurgical neurolysis, down to the identification of the Fontana bands, and the adequate postoperative splinting.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Contracture/surgery , Eye Abnormalities/surgery , Fingers/abnormalities , Gait , Knee Joint/abnormalities , Knee/innervation , Knee/surgery , Lower Extremity Deformities, Congenital/surgery , Nerve Expansion/methods , Plastic Surgery Procedures/methods , Postoperative Complications/surgery , Syndactyly/surgery , Urogenital Abnormalities/surgery , Abnormalities, Multiple , Child , Cleft Lip/physiopathology , Cleft Lip/rehabilitation , Cleft Palate/physiopathology , Cleft Palate/rehabilitation , Contracture/physiopathology , Contracture/rehabilitation , Eye Abnormalities/physiopathology , Eye Abnormalities/rehabilitation , Fingers/physiopathology , Fingers/surgery , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Lower Extremity Deformities, Congenital/physiopathology , Lower Extremity Deformities, Congenital/rehabilitation , Male , Microsurgery , Nerve Block , Postoperative Complications/physiopathology , Postoperative Complications/rehabilitation , Range of Motion, Articular , Plastic Surgery Procedures/adverse effects , Reoperation , Siblings , Splints , Syndactyly/physiopathology , Syndactyly/rehabilitation , Time Factors , Treatment Outcome , Urogenital Abnormalities/physiopathology , Urogenital Abnormalities/rehabilitationABSTRACT
We describe a 2.5 year-old child with toxic shock syndrome due to group A beta-hemolytic streptococcus (GABHS) who presented with purpura fulminans and limb ischemia treated with early microsurgical arteriolysis. The clinical picture of toxic shock syndrome (TSS) presenting with purpura fulminans and limb ischemia is an exceptionally uncommon finding in sepsis due to GABHS. This is the first case of purpura fulminans caused by GABHS reported in Europe and the third one described in the literature (Dhodapkar et al., 2000[1]; Renaud et a., 2011[2]).
