[Patient with homozygous sickle cell disease and free flap surgery: Ensuring the success of the procedure].
Sickle cell anaemia is rare in France but frequent in Africa, leading to rigid, sickle-like shape red blood cells which bind together blocking microcirculation under certain circumstances. The vaso-occlusive crisis is the most frequent clinical manifestation especially in case of homozygous disease. Sickle cells disease is therefore usually considerated as a contraindication to microsurgery, however sometimes, a free flap procedure is mandatory. We here report the case of a 47-year-old man suffering with homozygous sickle cell anaemia and needing an antebrachial free flap procedure for a tongue reconstruction. The postoperative course was unremarkable apart from a delayed healing which is common in this particular localization. A review of the litterature allows to list the precautions to be taken to ensure a microsurgical procedure with this medical background. The preoperative examination has to assess usual sickle cell disease comorbidities such as kidney failure, heart failure or pulmonary hypertension. All the events leading to either low output syndrome, hypoxia, hypothermia, or a stress caused by uncontrolled pain should be avoided per- and postoperatively. With an optimum medical care, microsurgery is possible even in patients suffering with sickle cells anaemia. This case is rare in France but will become frequent in Africa with the improvement of the healthcare system, allowing to give all patients the best medical care.
Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. Electronic address: Sophie.deneuve@lyon.unicancer.fr.
S
S
Deneuve
Département d'anesthésie réanimation, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
L
L
Maire
Département d'anesthésie réanimation, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
V
V
Bachelot
Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
M-A
MA
Dammacco
Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
P
P
Zrounba
Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
E
E
Delay
D000755:Anemia, Sickle Cell / Q000150:complications / Q000235:genetics* / Q000601:surgery*; D015897:Comorbidity; D005602:France; D058752:Free Tissue Flaps / Q000601:surgery*; D006720:Homozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D035583:Rare Diseases; D019651:Plastic Surgery Procedures / Q000379:methods*; D012307:Risk Factors; D014059:Tongue / Q000601:surgery*
Drépanocytose; Free flap; Lambeau libre; Microanastomose; Microanastomosis; Microchirurgie; Microsurgery; Sickle cells disease