[Falciform anemia and Plasmodium falciparum malaria: a threat to flap survival?].
Plasmodium falciparum malaria, a parasitic disease, and sickle cell anemia, a hereditary disease, are two diseases affecting erythrocyte cycle, occurring with a high prevalence in tropical Africa. They may induce microthrombosis inducing vaso-occlusion, organ dysfunction and flap necrosis. During the acute phase of Plasmodium falciparum malaria, destruction of parasitized and healthy erythrocytes, release of parasite and erythrocyte material into the circulation, and secondary host reaction occur. Plasmodium falciparum infected erythrocytes also sequester in the microcirculation of vital organs and may interfere with microcirculatory flow in the flap during the postoperative period. The lower legs of homozygous sickle cell anemia patients are areas of marginal vascularity where minor abrasions become foci of inflammation. Inflammation results in decreased local oxygen tension, sickling of erythrocytes, increased blood viscosity and thrombosis with consequent ischemia, tissue breakdown and leg ulcer. Tissue transfer has become the procedure of choice for reconstruction of the lower third of the leg although flaps may become necrotic. The aim of this study is to analyse circumstances predisposing to surgical complications and to define preventive and therapeutic measures. A review of the literature will describe the current research and the new perspectives to treat sickle cell anemia, for example hydroxyurea and vasoactive substances (pentoxifylline, naftidrofuryl, buflomedil).
Mariéthoz
S
S
Unité de Chirurgie Plastique et Reconstructive, Hôpitaux universitaires Genève, Suisse.
Pittet
B
B
Loutan
L
L
Humbert
J
J
Montandon
D
D
D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D000986:Antisickling Agents / Q000627:therapeutic use; D002648:Child; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D007871:Leg Ulcer / Q000209:etiology; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications*; D010431:Pentoxifylline / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology; D012106:Research; D012307:Risk Factors; D013524:Surgical Flaps; D014665:Vasodilator Agents / Q000627:therapeutic use
D000986:Antisickling Agents; D014665:Vasodilator Agents; D010431:Pentoxifylline; D006918:Hydroxyurea