Lemons Wesley J, Hampton Dallas, Satalich James, Cinats David
Department of Orthopedics, Virginia Commonwealth University, Richmond, Virginia.
School of Medicine , Eastern Virginia Medical School, Norfolk, Virginia.
J Orthop Case Rep. 2023 Aug;13(8):74-78. doi: 10.13107/jocr.2023.v13.i08.3822.
Free tissue transfer in the sickle cell population presents many challenges to the reconstructive surgeon. There are few reported cases of successful free tissue transfers within the sickle cell population. The majority of successful cases involve fasciocutaneous free flaps with few successful muscle flaps. This case report describes the successful utilization of a gracillis free flap to reconstruct a multifocal soft tissue defect following a closed distal tibia fracture in a patient with sickle cell disease (SCD).
This is a 20-year-old female with past medical history significant for sickle cell anemia, cardiomyopathy secondary to a ventricular septal defect and multiple occurrences of osteomyelitis who underwent gracilis free flap transfer to reconstruct soft tissue loss around the ankle after surgical fixation of a left pathological tibia fracture.
The use of free flaps in sickle cell patients has shown to be extremely challenging due to the high risks of sickling and subsequent pedicle thrombosis associated with this population. However, there have been an increasing number of successful cases of free tissue transfers with most of these flaps arising from muscular origins. Therefore, more cases regarding free flaps in the sickle cell population are needed to fully understand the best protocols to follow. The techniques utilized among successful cases, regarding protocols prior to the surgery along with successful graft location selection, can help advance future cases and shows promise for future sickle cell patients.
镰状细胞病患者的游离组织移植给重建外科医生带来了诸多挑战。镰状细胞病患者成功进行游离组织移植的报道病例较少。大多数成功病例涉及筋膜皮瓣游离移植，肌肉瓣游离移植成功的案例较少。本病例报告描述了在一名镰状细胞病（SCD）患者中，成功利用股薄肌游离皮瓣修复闭合性胫骨远端骨折后多灶性软组织缺损。
这是一名20岁女性，既往病史包括镰状细胞贫血、继发于室间隔缺损的心肌病以及多次骨髓炎发作，在对左侧病理性胫骨骨折进行手术固定后，接受了股薄肌游离皮瓣移植以修复踝关节周围的软组织缺损。
由于镰状细胞病患者存在镰变及随后蒂部血栓形成的高风险，在这类患者中使用游离皮瓣极具挑战性。然而，成功的游离组织移植病例数量不断增加，其中大多数皮瓣来源于肌肉组织。因此，需要更多关于镰状细胞病患者游离皮瓣的病例，以全面了解最佳治疗方案。成功病例中所采用的技术，包括术前方案以及成功的移植部位选择，有助于推动未来病例的进展，并为未来的镰状细胞病患者带来希望。
