Article Text

Download PDFPDF
Case report
Microsurgery in the sickle cell trait population: is it actually safe?
  1. Paul F Abraham,
  2. Omar Allam,
  3. Kitae Eric Park and
  4. Michael Alperovich
  1. Division of Plastic Surgery, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Michael Alperovich; michael.alperovich{at}


Although sickle cell disease has long been viewed as a contraindication to free flap transfer, little data exist evaluating complications of microsurgical procedures in the sickle cell trait patient. Reported is the case of a 55-year-old woman with sickle cell trait who underwent a deep inferior epigastric perforator microvascular free flap following mastectomy. The flap developed signs of venous congestion on postoperative day 2 but was found to have patent arterial and venous anastomoses on exploration in the operating room. On near-infrared indocyanine green angiography, poor vascular flow was noted despite patent anastomoses and strong cutaneous arterial Doppler signals. Intrinsic microvascular compromise or sickling remains a risk in the sickle cell trait population as it does for the sickle cell disease population. Just like in sickle cell disease patients, special care should be taken to optimise anticoagulation and minimise ischaemia-induced sickling for patients with sickle cell trait undergoing microsurgery.

  • surgical oncology
  • plastic and reconstructive surgery
  • sickle cell disease

Statistics from


  • Contributors PFA, OA and KEP wrote the manuscript with the guidance of MA. OA signed the consent and reached out to the patient to explain the case report and present the case report to the patient. MA supervised this project. All authors discussed the results and contributed to the final 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.