title: Free tissue transfer in patients with sickle cell disease: Considerations for multi-disciplinary peri-operative management.
abstract: OBJECTIVE
  Sickle cell disease (SCD) is an increasingly common condition in the UK. The safety of free tissue transfer in these patients is controversial, and no specific guidelines exist. The aim of this paper is to create recommendations for the plastic surgical multidisciplinary team for use in the assessment and management of SCD patients undergoing free tissue transfer and reconstruction.
  
  
  METHODS
  A literature review was performed in PubMed of 'sickle [TiAb] AND plast* adj3 surg*.
  
  
  RESULTS
  Sickle cell disease is explained, as is the relative peri-operative risk in different genotypes of SCD. Acute and chronic manifestations of SCD are described by system, for consideration at pre-operative assessment and post-operative review. The evidence surrounding free tissue transfer and SCD is discussed and the outcomes in published cases summarised. An algorithm for peri-operative multi-disciplinary management is outlined and justified.
  
  
  CONCLUSIONS
  Free tissue transfer theoretically carries a high risk of a crisis, due not only to long anaesthetic times, but the potential requirement for tourniquet use, and the relatively hypoxic state of the transferred tissue. This paper outlines a useful, practical algorithm to optimise the safety of free tissue transfer in patients with SCD.
authors.affiliation: Queen Victoria Hospital, East Grinstead, United Kingdom. Electronic address: lillicooper@doctors.org.uk.
authors.forename: Lilli
authors.initials: L
authors.lastname: Cooper
authors.affiliation: Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Rohit
authors.initials: R
authors.lastname: Seth
authors.affiliation: St George's Hospital, London, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rhodes
authors.affiliation: The Royal Free Hospital, London, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alousi
authors.affiliation: Great Ormond Street Hospital, London, United Kingdom; The Royal Free Hospital, London, United Kingdom.
authors.forename: Bran
authors.initials: B
authors.lastname: Sivakumar
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications* / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D019990:Perioperative Care; D019651:Plastic Surgery Procedures
keywords: Free flap; Replant; Sickle cell disease; Sickle cell trait; Toe-to-hand transfer