Spence R J
Plast Reconstr Surg. 1985 Oct;76(4):616-9. doi: 10.1097/00006534-198510000-00026.
This paper describes what is thought to be the first reported use of a free flap in a patient with homozygous sickle cell disease. The utilization of a free flap in homozygous sickle cell disease should be questioned because the obligate period of ischemia to which the flap must be subjected during the transfer from donor to recipient sites might lead to intravascular sickling in the flap and flap failure. Review of the literature suggests that by reducing the level of sickle hemoglobin to the range of 25 to 40 percent, the risk of failure of a free flap is not significantly increased in the homozygous sickle cell patient. Furthermore, there is good evidence to suggest that a well-vascularized muscle flap provides optimal coverage, reversing the pathophysiologic cycle of the sickle cell ulcer. Thus in cases of multiply recurrent sickle cell ulcers in areas devoid of a local well-vascularized muscle flap, a free muscle flap is indicated, may be the procedure of choice, and can be performed successfully. We report a patient with a 4-year history of multiple recurrent sickle cell ulcers of the left ankle treated with a gracilis free flap. This patient has been followed for 2 years and continues to be free of recurrent ulceration.
本文描述了在一名纯合子镰状细胞病患者中首次报道使用游离皮瓣的情况。在纯合子镰状细胞病中使用游离皮瓣应受到质疑，因为在将皮瓣从供体部位转移到受体部位的过程中，皮瓣必须经历的缺血期可能会导致皮瓣内血管镰状化和皮瓣失败。文献回顾表明，将镰状血红蛋白水平降低到25%至40%的范围内，纯合子镰状细胞病患者游离皮瓣失败的风险不会显著增加。此外，有充分的证据表明，血管化良好的肌皮瓣能提供最佳的覆盖，逆转镰状细胞溃疡的病理生理循环。因此，在缺乏局部血管化良好的肌皮瓣的区域出现多次复发性镰状细胞溃疡的情况下，游离肌皮瓣是适用的，可能是首选的手术方法，并且可以成功实施。我们报告了一名有4年左踝多次复发性镰状细胞溃疡病史的患者，其接受了股薄肌游离皮瓣治疗。该患者已随访2年，继续无复发性溃疡。
