title: Microsurgical free flap transfer in sickle cell disease.
abstract: A patient with sickle cell anemia and recurrent ankle ulceration is presented. Multiple previous skin grafts did not resolve the painful ulcers. A radial forearm free flap was attempted. Despite preoperative transfusions to reduce her hemoglobin S levels, postoperative thrombosis occurred. The true risk of free flap failure in sickle cell anemia is unknown and there is still debate about the exact nature of the hypercoagulable state that exists in this disease. We recommend, however, that consideration is given to the use of prophylactic anticoagulation in patients undergoing complex procedures or in whom other risk factors have been identified.
authors.affiliation: Division of Plastic Surgery, University of Toronto, Toronto General Hospital, Ontario, Canada.
authors.forename: R S
authors.initials: RS
authors.lastname: Richards
authors.forename: C V
authors.initials: CV
authors.lastname: Bowen
authors.forename: M F
authors.initials: MF
authors.lastname: Glynn
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D000842:Ankle; D016913:Blood Component Transfusion; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D013300:Streptokinase / Q000627:therapeutic use; D013524:Surgical Flaps; D013927:Thrombosis / Q000209:etiology* / Q000628:therapy
chemical_list: D006493:Heparin; D013300:Streptokinase