Free tissue transfer in patients with sickle cell disease: Considerations for multi-disciplinary peri-operative management

Cooper, Lilli; Seth, Rohit; Rhodes, Elizabeth; Alousi, Mohammed; Sivakumar, Branavan

doi:10.1016/j.bjps.2016.10.005

Cited by 6 publications

(43 citation statements)

References 36 publications

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“…If neonatal screening for hemoglobinopathies is implemented locally, some authors, in reviews and retrospective studies, do not see the need for pre‐operative screening . If such intervention is not available, a preoperative screening in patients from endemic regions is suggested in several reviews . Universal preoperative screening for SCD is not recommended by any of the reviewed reports or guidelines.…”

Section: Resultsmentioning

confidence: 99%

“…A multidisciplinary collaboration and communication between the surgeon, anesthetist, hematologist and blood bank specialist are universally considered to be mandatory, although specific study data is not available to support this unanimous recommendation . When required, the preemptive and planned coordination with an ICU team for post‐operative admission and care is suggested . The systematic preoperative assessment of SCD patients varies considerably in its implementation and/or description.…”

Section: Resultsmentioning

confidence: 99%

“…The systematic preoperative assessment of SCD patients varies considerably in its implementation and/or description. As expected, collecting a medical history and performing a physical examination is a standard recommendation . In particular, the documentation of a personal pain management history is part of some assessments, and aims to facilitate postoperative interventions and decision‐making in non‐opioid naïve patients .…”

Section: Resultsmentioning

confidence: 99%

“…As expected, collecting a medical history and performing a physical examination is a standard recommendation . In particular, the documentation of a personal pain management history is part of some assessments, and aims to facilitate postoperative interventions and decision‐making in non‐opioid naïve patients . Some authors suggest a complete clinical examination of the nervous system and imaging, such as transcranial Doppler ultrasound, cerebral angiography or MRI if indicated .…”

Section: Resultsmentioning

confidence: 99%

“…In particular, the documentation of a personal pain management history is part of some assessments, and aims to facilitate postoperative interventions and decision‐making in non‐opioid naïve patients . Some authors suggest a complete clinical examination of the nervous system and imaging, such as transcranial Doppler ultrasound, cerebral angiography or MRI if indicated . A chest radiograph is often performed as part of the work‐up: universally, or only if and when clinically indicated .…”

Section: Resultsmentioning

confidence: 99%

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Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

et al. 2019

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Children with sickle cell disease (SCD) require specific perioperative care, and clinical practice in this area remains poorly defined. We aimed to conduct a systematic, PRISMA-based review of the literature, available clinical guidelines and practice recommendations. We also aimed to extract any valuable information for the "best of available-evidence"-based prevention of perioperative adverse events in children with SCD, and highlight the most urgent priorities in clinical research. As data sources, USWe also included institutional, consortia and expert group guidelines. Included were reports/guidelines in English, French, German, and Italian. Excluded were reports on obstetrical and fetal management. We identified 202 reports/guidelines fulfilling the criteria outlined above. A majority focused on visceral, cardiovascular and orthopedic surgery procedures, and only five were multicenter randomized controlled trials and two prospective randomized studies. After grading of the quality of the evidence, the extracted data was summarized into clinical recommendations for daily practice. Additionally, we designed a risk-grading algorithm to identify contexts likely to be associated with adverse outcomes. In conclusion, we provide a systematic PRISMA-based review of the existing literature and ancillary practice and delineate a set of clinical recommendations and priorities for research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

et al. 2019

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Free Tissue Transfer in Sickle Cell Disease: A Case Report and Systematic Review

2023

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Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords “free tissue transfer,” “free flap,” or “microsurgery” and “sickle cell” on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

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Should Sickle Cell Trait Be a Contraindication to Breast Reconstruction?—A Case Series Analysis

Webster

Araya

Bartolacci

et al. 2023

J Reconstr Microsurg Open

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Background While sickle cell disease has long been considered a contraindication to breast free flap reconstruction, there have been less definitive decisions about the impact of sickle cell trait on these procedures. We sought to analyze the patients with sickle cell trait who underwent free deep inferior epigastric perforator (DIEP) flap and pedicled latissimus dorsi (LD) flap at a single institution to determine the reconstructive outcomes. Methods Patients with sickle cell trait who underwent breast free DIEP and pedicled LD reconstruction from 2007 to 2021 at a single institution by the lead surgeon were analyzed for demographics and surgical outcomes. Results Four patients were identified as having sickle cell trait and having undergone a breast flap reconstruction. The average age of the patients was 54 years, median body mass index was 25, and past medical history was notable for one patient being a current smoker, and one patient having hypertension. Two patients received a unilateral free DIEP flap, one received a bilateral free DIEP flap, and one received a unilateral pedicled LD flap for a total of five flaps in four patients. Three of the patients received prior hormone therapy, one received prior radiation therapy, and one received prior chemotherapy. There were no instances of flap failure, vessel thrombosis, pulmonary embolism, or deep venous thrombosis. One patient experienced wound dehiscence. Conclusion In this case series we present four patients with sickle cell trait who successfully underwent breast flap reconstruction without any instances of flap or systemic thrombosis. More work is needed to determine how to pre- and postoperatively optimize patients with sickle cell trait for favorable breast flap reconstruction outcomes.

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Free tissue transfer in patients with sickle cell disease: Considerations for multi-disciplinary peri-operative management

Cited by 6 publications

References 36 publications

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

Free Tissue Transfer in Sickle Cell Disease: A Case Report and Systematic Review

Should Sickle Cell Trait Be a Contraindication to Breast Reconstruction?—A Case Series Analysis

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