Gracilis Free Flap in a Patient with Sickle Cell Disease.

INTRODUCTION: Free tissue transfer in the sickle cell population presents many challenges to the reconstructive surgeon. There are few reported cases of successful free tissue transfers within the sickle cell population. The majority of successful cases involve fasciocutaneous free flaps with few successful muscle flaps. This case report describes the successful utilization of a gracillis free flap to reconstruct a multifocal soft tissue defect following a closed distal tibia fracture in a patient with sickle cell disease (SCD).

CASE REPORT: This is a 20-year-old female with past medical history significant for sickle cell anemia, cardiomyopathy secondary to a ventricular septal defect and multiple occurrences of osteomyelitis who underwent gracilis free flap transfer to reconstruct soft tissue loss around the ankle after surgical fixation of a left pathological tibia fracture.

CONCLUSION: The use of free flaps in sickle cell patients has shown to be extremely challenging due to the high risks of sickling and subsequent pedicle thrombosis associated with this population. However, there have been an increasing number of successful cases of free tissue transfers with most of these flaps arising from muscular origins. Therefore, more cases regarding free flaps in the sickle cell population are needed to fully understand the best protocols to follow. The techniques utilized among successful cases, regarding protocols prior to the surgery along with successful graft location selection, can help advance future cases and shows promise for future sickle cell patients.