Microsurgery in the Sickle Cell Trait Population: Can it Be Safely and Successfully Performed?

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Hematology

Background:

• Free-tissue transfer reconstruction in sickle cell anemia patients carries risks due to sickle hemoglobin polymerization in flap microcirculation.
• Most literature focuses on sickle cell disease, a contraindication for microsurgery, with fewer reports on sickle cell trait (SCT).

Observation:

• A 52-year-old woman with SCT underwent deep inferior epigastric perforator (DIEP) free-tissue transfer for breast reconstruction after failed alloplastic reconstruction.
• Postoperative Doppler confirmed patent arterial and venous anastomoses. Blistering and partial flap necrosis occurred on postoperative days 8 and 15, respectively.
• Debridement and closure successfully managed flap complications; the flap remained well-perfused and incorporated at 5 months.

Findings:

• This case reports a successful microsurgical breast reconstruction using DIEP free-tissue transfer in a patient with sickle cell trait (SCT).
• The patient experienced minor flap complications (blistering, partial necrosis) that were successfully managed, with a good long-term outcome.

Implications:

• This case expands the limited evidence supporting the safety and feasibility of autologous microsurgical reconstruction in patients with the heterozygous sickle cell trait phenotype.
• Highlights the potential for successful free-tissue transfer in select patients with sickle cell trait, challenging previous contraindications.