Published online Nov 6, 2016. doi: 10.5315/wjh.v5.i4.94
Peer-review started: May 23, 2016
First decision: July 27, 2016
Revised: October 12, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: November 6, 2016
We present an 18-year-old female with sickle cell disease, who presented with an extensive lower leg ulcer over a 12-year course of the disease. Definitive reconstruction was made using a free latissimus dorsi flap and split-skin grafts. One week before the surgery, the plasmapheresis protocol and blood transfusion were administered, in order to achieve a hemoglobin S level of ≤ 30%. Intraoperatively, the flap pedicle was rinsed with plasminogen activator inhibitor-1 until the thrombolytic agent was obtained from the comitant vein; after the arterial flow had been released, an intravenous bolus dose of heparin (2000 U) was administrated. No vascular complications occurred. Postoperatively, the patient received a 10-d course of hemodilution and a 14-d course of full-dose anticoagulation. After 8 mo postoperatively, the patient was able to walk and run, and showed complete wound healing. This case indicates that sickle cell disease is not a contraindication to free tissue transfer; however, the complications, their rate and overall outcomes for these cases are not yet clear. Herein, we provide an algorithm based on our clinical experience in this type of case and treatment, including several recommendations that may help to reduce thrombosis risk and systemic complications.
Core tip: This is a case report of a successful microsurgical reconstruction in a patient with sickle cell disease who presented with an extensive lower leg ulcer during a 12-year course of the disease. We provide several recommendations for plasmapheresis and blood transfusions before the surgical reconstruction, and the anticoagulation protocol during the procedure and the postoperative period. This case description is intended to increase our colleagues’ motivation to perform microsurgical reconstruction with a safer approach in the presence of hematologic diseases with elevated risk of thrombosis.