Clinical examination at hospital admission revealed jaundice, bilateral thrombocytopenic purpura of the thighs and calves, two indurated oval purple lesions (0.5 cm in diameter) suggestive for ecthyma gangrenosum, on the anterointernal
side of the left calf, abdominal spider angioma and spontaneous bleeding (epistaxis, melena, bleeding gums and rectorrhagia.
Following disinfection of the zone and under aseptic conditions, we performed an incision in the anterointernal
proximal zone of the tibia, since this access is scantly traumatic and causes limited bleeding.
(8) Many methods of fixation for QTA have been described, including the quadriceps-tendon patellar-bone composite autograft (11); fixation of the graft, both in the femur and the tibia, using absorbable cross pins (16); and fixation of the patellar bone in the femoral tunnel, with the tendinous extremity of the graft pulled by nonabsorbable wires, remaining firmly fixed by a staple or a screw in the anterointernal
cortex of the tibia.