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Microsurgery in the sickle cell trait population: is it actually safe?
Paul F Abraham1, Omar Allam1, Kitae Eric Park1
1Division of Plastic Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
BMJ Case Reports
|May 9, 2020
Summary
Sickle cell trait patients undergoing microsurgery, like deep inferior epigastric perforator free flaps, face risks of vascular compromise. Careful anticoagulation and minimizing ischemia are crucial for these patients.
Area of Science:
- Microsurgery
- Vascular Surgery
- Hematology
Background:
- Sickle cell disease is often considered a contraindication for free flap transfer.
- Limited data exist on microsurgical complications in sickle cell trait patients.
Observation:
- A case report details a 55-year-old woman with sickle cell trait undergoing a deep inferior epigastric perforator microvascular free flap post-mastectomy.
- The flap showed venous congestion on postoperative day 2, despite patent arterial and venous anastomoses.
- Near-infrared indocyanine green angiography revealed poor vascular flow despite patent anastomoses.
Findings:
- Intrinsic microvascular compromise or sickling is a potential risk in sickle cell trait patients undergoing microsurgery.
- Patent anastomoses do not preclude vascular compromise in this population.
Implications:
- Patients with sickle cell trait require meticulous anticoagulation management during microsurgery.
- Minimizing ischemia-induced sickling is essential for successful outcomes in sickle cell trait patients undergoing microsurgical procedures.
