Eliseo Sara, Berlin Levana, Mansour Ahmed M, Hansen Susan, Ranganath Bharat, Wallace Sean J
From Philadelphia College of Osteopathic Medicine, Moultrie, Ga.
Lehigh Valley Health Network, Allentown, Pa.
Plast Reconstr Surg Glob Open. 2023 Nov 7;11(11):e5377. doi: 10.1097/GOX.0000000000005377. eCollection 2023 Nov.
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.
镰状细胞贫血患者进行游离组织移植重建存在风险，因为镰状血红蛋白会在皮瓣微循环内聚合，导致手术失败。然而，由于聚合量取决于疾病表型/诊断、缺氧程度和细胞内脱水等因素，其结果各不相同。大多数文献关注的是镰状细胞病患者，该病会产生更高浓度的镰状血红蛋白，因此是微血管重建的禁忌症。较少有报告描述携带杂合子表型的镰状细胞性状（SCT）患者的显微外科手术。在此，我们报告一例SCT患者接受显微外科乳房重建并采用腹壁下深动脉穿支游离组织移植的病例。这位52岁的女性此前因乳腺癌接受放疗后，基于假体的重建手术失败。在我们的病例中，临床和多普勒检查表明动静脉吻合口保持通畅；因此患者在术后第4天出院。术后第8天出现水泡，到第15天，腹壁下深动脉穿支皮瓣的下外侧部分出现部分坏死。清创和缝合解决了问题，术后5个月，皮瓣血运良好且愈合良好。本病例经患者同意后呈现，报告了SCT患者显微外科重建的成功结果。它扩展了有限的证据，以支持对镰状细胞贫血杂合子表型患者进行自体手术干预的安全性和可行性。
