Patients with homozygous sickle cell disease pose an enormous challenge to the reconstructive surgeon. Historically, the risk of attempting flap reconstruction was considered prohibitive. A successful case of immediate breast reconstruction with a “supercharged” bipedicled transverse rectus abdominis musculocutaneous flap is presented. Perioperative transfusions that maintained the sickle hemoglobin S level below 30% were crucial in preventing erythrocyte sickling in the microcirculation of the flap during the period of relative ischemia.
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