Lower Limb Salvage by Microvascular Free-Tissue Transfer in Patients with Homozygous Sickle Cell Disease

Weinzweig, Norman; Schuler, James J.; Marschall, Michael A.; Koshy, Mabel

doi:10.1097/00006534-199510000-00024

Cited by 23 publications

(24 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be particularly useful in individuals with SCD who have high rates of zinc deficiency. Skin grafts and myocutaneous flaps have been used for recalcitrant ulcers resistant to local therapy; however results are equivocal as there remains a high risk of thrombotic occlusion of graft microvasculature [251]. Short-duration chronic hypertransfusion therapy may reduce anesthetic risk and improve chances of graft success along with anticoagulants and or antiplatelet agents [249, 252].…”

Section: Muscular/skeletal/skin Complicationsmentioning

confidence: 99%

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Ballas

Kesen

Goldberg

et al. 2012

The Scientific World Journal

158

144

View full text Add to dashboard Cite

The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.

show abstract

Section: Muscular/skeletal/skin Complicationsmentioning

confidence: 99%

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Ballas

Kesen

Goldberg

et al. 2012

The Scientific World Journal

158

144

View full text Add to dashboard Cite

show abstract

“…In our experience, skin biopsies and surgical interventions heal well and are not contraindicated. Surgeons may offer placement of skin grafts, either partial or full thickness, or even vascular pedicle skin grafts [88][89][90]. Grafts have a high rate of failure, and we consider preoperative and postoperative red cell transfusion in an attempt to facilitate engraftment, although this is of uncertain benefit.…”

Section: Role Of Consultantsmentioning

confidence: 99%

Critical Reviews: How we treat sickle cell patients with leg ulcers

Minniti

Kato

2015

American J Hematol

View full text Add to dashboard Cite

The past five decades have seen an improvement in the mortality and morbidity of sickle cell disease (SCD) because of prophylaxis against infectious complications, improved and expanded red cell transfusions, implementation of hydroxyurea therapy, and advances in supportive care. Now that the majority of patients in the western hemisphere reaches adulthood, end organ diseases are frequent, which include vasculopathic complications such as chronic leg ulcers. The management of patients with leg ulcers requires the hematologist to lead a team of health care professionals, and investigates the presence of associated, but potentially still occult signs of vasculopathy, such as pulmonary hypertension, renal disease, priapism and retinopathy. These complications may be asynchronous, and long term careful screening is indicated, in order to ensure early diagnosis and intervention. It is crucial to address both the immediate consequences of pain, infection and disability, and long term effects on quality of life, employment and stigma associated with chronic ulceration. Recent insights into their pathophysiology may have practical implications. We propose a holistic approach to the management of patients' physical and emotional problems and mechanisms of ulcers formation and delayed healing. An overview of topical and systemic therapies for chronic ulcers is given, with the understanding that wound care therapy is best left to the wound specialists, medical and surgical, with whom the hematologist must keep an open line of communication. In the absence of evidence-based guidelines, our opinion is based on both a critical review of the literature and our personal clinical and research experience. Am. J. Hematol. 91:22-30, 2016. V C 2015 Wiley Periodicals, Inc. Clinical CasesCase 1. A 49 year old African American woman with sickle cell anemia, bilateral hip replacements for avascular necrosis of the femoral head, pulmonary arterial hypertension documented by pulmonary artery catheterization, and history of laser treatment and vitrectomy for proliferative retinopathy and vitreous hemorrhage, presented with a very painful ulcer at the right malleolus. She has had three previous ulcers, on both legs, the first at age 32 years, attributed to excessive standing at her job, no trauma, which had responded to topical care and healed within few months of presentation. At that time she was not taking hydroxyurea, but has been taking it now for longer than 10 years with good fetal hemoglobin response: 17%. This current ulcer developed while she was experiencing high personal stress but no physical trauma. She rarely experiences vaso-occlusive pain crisis and has very infrequent hospitalizations. She was referred to the wound care service and after 7 months of unfruitful therapies, including surgical debridement, MIST ultrasound therapy, antibiotics, and compressions, she was started on monthly transfusions and her ulcer healed 5 months later. She has had consistently elevated serum lactate dehydrogenase (LDH) (>600 IU/L), serum dire...

show abstract

“…19 Increased number of deformed blood components, as in the cases of hereditary hematological disorders, also represents an important factor to cause thrombosis during or after microsurgical procedures. [20][21][22][23][24][25][26][27][28][29] However, in 2013, Mlodinow et al conducted multiinstitutional data analysis in free flap transfer and concluded that anemia is not a predictor of free flap failure. 30 Many traumatic injuries or chronic inflammation are known to induce reactive thrombocytosis 18,31,32 and may trigger platelet activation.…”

Section: Discussionmentioning

confidence: 99%

The outcome of free tissue transfers in patients with hematological diseases: 20‐year experiences in single microsurgical center

et al. 2014

View full text Add to dashboard Cite

show abstract

Lower Limb Salvage by Microvascular Free-Tissue Transfer in Patients with Homozygous Sickle Cell Disease

Cited by 23 publications

References 0 publications

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Critical Reviews: How we treat sickle cell patients with leg ulcers

The outcome of free tissue transfers in patients with hematological diseases: 20‐year experiences in single microsurgical center

Contact Info

Product

Resources

About