Introduction: Meningococcal sepsis in infants often results in devastating amputations of fingers, toes, upper or lower limbs. It is our experience that the extent of skin necrosis does match the muscle necrosis. Materials and Methods: When Doppler evaluation of the major limb vessels shows an interruption of blood flow we than immediately perform an escharotomy, fasciotomy added with an arteriolysis. This is performed within the first few hours after admission of the patient to the paediatric intensive care. At that time vasopressor drugs such as adrenaline are given at high concentrations. The arteriolysis cosists out of a liberation of the arteries from their surrounding fibrous sheets , connective tissues , sympathetic nerves and committant veins. Microsurgical magnification is mandatory since the radial or tibial artery diameter in a one year old infants does not exceed one millimetre. It is our experience that trombus formation in the vessel lumen is very rare although no blood flow may be present ,due to extrinsic compression, leading to ischemic necrosis. After arteriolysis the extent of skin lesions in Meningococcal Sepsis does not match anymore the occlusion of the mayor limb vessels and its accompanying muscle necrosis ,which is more limited. In 8 infants we have applied this technique. Arteriolysis finally resulted in the following permanent lesions: Fingertip necrosis in 4/32 fingers in 4 patients. One FTG corrected a contracted index. Distal nail necrosis was found in 1 finger of a total ischemia of a distal upper arm and forearm . One midfoot amputation occurred when arteriolysis was performed at 37 hours . One distal foot amputation was found after early arteriolysis down to the midfoot level exposing the plantar artery. 3 toes were lost after arteriolysis from mid –calf down to the plantar artery distal to the tarsal tunnel.

Conclusion: Early arteriolysis allows us to restore the blood supply to the musculo-skeletal system with only a terminal occlusion of the skin vessels which is not reversible.