Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed?
Publication/Presentation Date
11-1-2023
Abstract
Free-tissue transfer reconstruction in patients with sickle cell anemia risks failure due to polymerization of sickle hemoglobin within the flap microcirculation. However, outcomes vary, as the amount of polymerization is dependent on factors such as disease phenotype/diagnosis, degree of hypoxia, and intracellular dehydration. Most of the literature focuses on patients with sickle cell disease, which produces higher concentrations of sickle hemoglobin and, therefore, is a contraindication to microvascular reconstruction. Fewer reports describe microsurgery in patients with sickle cell trait (SCT) who carry the heterozygous phenotype. Here, we present a case in which a patient with SCT underwent microsurgical breast reconstruction with deep inferior epigastric perforator free-tissue transfer. The 52-year-old woman had previously experienced a failed alloplastic-based reconstruction after radiation therapy for breast cancer. In our case, clinical and Doppler examinations demonstrated that arterial and venous anastomoses had remained patent; so the patient was discharged on postoperative day 4. Blistering developed on postoperative day 8, and by day 15 there was partial necrosis of the inferior-lateral aspect of the deep inferior epigastric perforator flap. Debridement and closure resolved the issue, and at 5 months postprocedure, the flap remained well-perfused and well-incorporated. This case, presented here with patient consent, reports a successful outcome of microsurgical reconstruction in a patient with SCT. It expands the limited evidence to support the safety and feasibility of autologous surgical interventions for patients with the heterozygous phenotype of sickle cell anemia.
Volume
11
Issue
11
First Page
5377
Last Page
5377
ISSN
2169-7574
Published In/Presented At
Eliseo, S., Berlin, L., Mansour, A. M., Hansen, S., Ranganath, B., & Wallace, S. J. (2023). Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed?. Plastic and reconstructive surgery. Global open, 11(11), e5377. https://doi.org/10.1097/GOX.0000000000005377
Disciplines
Medicine and Health Sciences
PubMedID
37941817
Department(s)
Department of Surgery, Fellows and Residents
Document Type
Article