• Lilli Cooper, Rohit Seth, Elizabeth Rhodes, Mohammed Alousi, and Bran Sivakumar.
• Queen Victoria Hospital, East Grinstead, United Kingdom. Electronic address: lillicooper@doctors.org.uk.
• J Plast Reconstr Aesthet Surg. 2017 Jan 1; 70 (1): 12-24.

Introduction And AimsSickle cell disease (SCD) is an increasingly common condition in the UK. The safety of free tissue transfer in these patients is controversial, and no specific guidelines exist. The aim of this paper is to create recommendations for the plastic surgical multidisciplinary team for use in the assessment and management of SCD patients undergoing free tissue transfer and reconstruction.MethodA literature review was performed in PubMed of 'sickle [TiAb] AND plast* adj3 surg*.ResultsSickle cell disease is explained, as is the relative peri-operative risk in different genotypes of SCD. Acute and chronic manifestations of SCD are described by system, for consideration at pre-operative assessment and post-operative review. The evidence surrounding free tissue transfer and SCD is discussed and the outcomes in published cases summarised. An algorithm for peri-operative multi-disciplinary management is outlined and justified.ConclusionFree tissue transfer theoretically carries a high risk of a crisis, due not only to long anaesthetic times, but the potential requirement for tourniquet use, and the relatively hypoxic state of the transferred tissue. This paper outlines a useful, practical algorithm to optimise the safety of free tissue transfer in patients with SCD.Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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