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Craniectomy with microvascular flap reconstruction in a patient taking infliximab for vasculitis
  1. Ogonna N Nnamani Silva1,
  2. Audrey B Nguyen2 and
  3. William Y Hoffman2
  1. 1School of Medicine, University of California, San Francisco, San Francisco, California, USA
  2. 2Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Ogonna N Nnamani Silva; ogonna.nnamani{at}ucsf.edu

Abstract

For patients whose vasculitis is managed with biologic medications, no reports or evidence-based guidance exists regarding the perioperative management of microvascular flaps. We present a case of a 78-year-old patient with Takayasu’s arteritis (TA) and diabetes mellitus who was taking infliximab and underwent wide local excision of squamous cell carcinoma, craniectomy and reconstruction with a latissimus dorsi flap. TA, an immune-mediated large cell vasculitis characterised by granuloma formation, tends to affect larger vessels and aortic branches. The typical localisation of this condition raises concerns about potentially compromised pedicle and recipient vessels (ie, superficial temporal arteries), which could hinder postoperative flap success. Discontinuation of infliximab 4 weeks before surgery and resumption 6 weeks after led to favourable results. This case addresses the gap in the literature concerning stopping and restarting biologic drugs in the perioperative setting and documents a successful course of a microvascular procedure in a patient with vasculitis.

  • Immunological products and vaccines
  • immunology
  • skin cancer
  • plastic and reconstructive surgery

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Footnotes

  • Twitter @OgonnaNnamani

  • Contributors All authors participated in the surgical care of the patient described in the case report. WYH and ABN were the primary surgeons assigned to this case and supervised the project, provided edits, comments and assisted with subsequent manuscript revisions. ONNS drafted the earlier versions of the manuscript and worked with WYH, ABS, and PD to edit and develop the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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