Use of bone scan in management of patients with peripheral gangrene due to fulminant meningococcemia

Technetium bone scintigraphy was performed in four patients with fulminant meningococcemia and extensive peripheral gangrene. The bone scans showed variable levels of absent uptake in all extremities of the four patients who subsequently required quadrimembral amputations. In 13 limbs, the level of amputation was determined primarily by the bone scan findings, and operation was successful in 84% of those limbs. These findings suggest that bone scanning is a useful adjunct in differentiating viable from nonviable tissues in patients with extensive peripheral gangrene secondary to fulminant meningococcemia and thus helps determine the appropriate level of amputation in such patients.