Meningococcal disease affects as many as 3,000 people in the United States per year, with the highest incidence in children younger than two years of age and two-thirds of cases occurring in children younger than five years of age. Children who survive meningococcemia face quality-of-life issues that result from limb deficiencies. Consultation with an experienced pediatric orthopedic surgeon in the early stages of the illness is vital for planning surgical approaches for amputation of the resulting necrotic tissue and for minimizing eventual tissue loss. Early surgical intervention is rarely indicated in cases of extremity gangrene unless a secondary infection is present. Allowing time for tissue demarcation and recovery can be essential for limb length preservation. Maintaining functional joints is important for long-term quality of life and activities of daily living.