Fat and Skin Grafting for Chronic Sickle Cell Ulcers
Fat and Skin Grafting for Chronic Sickle Cell Ulcers
The patient is a 34-year-old woman with sickle cell disease. Her prior medical history was significant for hepatitis C, contracted from a blood transfusion she received as a child. She has no allergies and takes no daily medications. The patient presented to the authors' clinic with a 1-year history of a nonhealing 3 cm x 6 cm ulcer on her right medial ankle, with no exposed tendon or bone. The wound demonstrated no evidence of infection, and she had no other signs of vasculopathy on either lower extremity. She did not recall any incident of trauma to the site, and had no associated fevers. She did report that the wound was very painful, and that it had occurred independently of a sickle cell crisis.
As a first stage of treatment, the wound was debrided in preparation for skin grafting. Local wound care continued weekly until the wound demonstrated a healthy, granulating bed. Three months after initial presentation, a split-thickness skin graft was performed. Postoperatively, the wound was dressed with a V.A.C. dressing (KCI, San Antonio, TX) and then managed weekly with Unna boot dressing changes. At 4 weeks postoperatively, the patient presented with breakdown at the wound site and partial loss of the skin graft. Local wound care continued, but ultimately, the graft was lost. The patient continued to report severe pain at the site of the ulcer, and was prescribed narcotic medication as part of her treatment.
For the next 6 months, the wound was managed with daily wet-to-dry dressings and light compression. Although the wound bed was clean and granulating, there was no evidence of wound contraction or re-epithelialization at the site of graft loss. The patient began experiencing depression over the situation, and she requested another attempt at surgical management. At this time, the wound was 3 cm x 7 cm in diameter.
Case Report
The patient is a 34-year-old woman with sickle cell disease. Her prior medical history was significant for hepatitis C, contracted from a blood transfusion she received as a child. She has no allergies and takes no daily medications. The patient presented to the authors' clinic with a 1-year history of a nonhealing 3 cm x 6 cm ulcer on her right medial ankle, with no exposed tendon or bone. The wound demonstrated no evidence of infection, and she had no other signs of vasculopathy on either lower extremity. She did not recall any incident of trauma to the site, and had no associated fevers. She did report that the wound was very painful, and that it had occurred independently of a sickle cell crisis.
As a first stage of treatment, the wound was debrided in preparation for skin grafting. Local wound care continued weekly until the wound demonstrated a healthy, granulating bed. Three months after initial presentation, a split-thickness skin graft was performed. Postoperatively, the wound was dressed with a V.A.C. dressing (KCI, San Antonio, TX) and then managed weekly with Unna boot dressing changes. At 4 weeks postoperatively, the patient presented with breakdown at the wound site and partial loss of the skin graft. Local wound care continued, but ultimately, the graft was lost. The patient continued to report severe pain at the site of the ulcer, and was prescribed narcotic medication as part of her treatment.
For the next 6 months, the wound was managed with daily wet-to-dry dressings and light compression. Although the wound bed was clean and granulating, there was no evidence of wound contraction or re-epithelialization at the site of graft loss. The patient began experiencing depression over the situation, and she requested another attempt at surgical management. At this time, the wound was 3 cm x 7 cm in diameter.
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