Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed?
Summary:. 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...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-11-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005377 |
| _version_ | 1797449469858414592 |
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| author | Sara Eliseo, MS Levana Berlin, DO Ahmed M. Mansour, MD Susan Hansen, MA Bharat Ranganath, MD Sean J. Wallace, MD, MS |
| author_facet | Sara Eliseo, MS Levana Berlin, DO Ahmed M. Mansour, MD Susan Hansen, MA Bharat Ranganath, MD Sean J. Wallace, MD, MS |
| author_sort | Sara Eliseo, MS |
| collection | DOAJ |
| description | Summary:. 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. |
| first_indexed | 2024-03-09T14:26:31Z |
| format | Article |
| id | doaj.art-189aa3db69b6408c92c978779bb84779 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-03-09T14:26:31Z |
| publishDate | 2023-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-189aa3db69b6408c92c978779bb847792023-11-28T07:10:12ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742023-11-011111e537710.1097/GOX.0000000000005377202311000-00014Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed?Sara Eliseo, MS0Levana Berlin, DO1Ahmed M. Mansour, MD2Susan Hansen, MA3Bharat Ranganath, MD4Sean J. Wallace, MD, MS5From * Philadelphia College of Osteopathic Medicine, Moultrie, Ga.† Lehigh Valley Health Network, Allentown, Pa.† Lehigh Valley Health Network, Allentown, Pa.† Lehigh Valley Health Network, Allentown, Pa.‡ George Washington University Plastic Surgery, Washington, D.C.‡ George Washington University Plastic Surgery, Washington, D.C.Summary:. 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.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005377 |
| spellingShingle | Sara Eliseo, MS Levana Berlin, DO Ahmed M. Mansour, MD Susan Hansen, MA Bharat Ranganath, MD Sean J. Wallace, MD, MS Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed? Plastic and Reconstructive Surgery, Global Open |
| title | Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed? |
| title_full | Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed? |
| title_fullStr | Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed? |
| title_full_unstemmed | Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed? |
| title_short | Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed? |
| title_sort | microsurgery in the sickle cell trait population can it be safely and successfully performed |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005377 |
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