Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2023; 11(17): 4079-4083
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4079
Successful reconstruction of an ankle defect with free tissue transfer in a hemophilia A patient with repetitive hemoarthrosis: A case report
Dong Yun Lee, SooA Lim, SuRak Eo, Jung Soo Yoon
Dong Yun Lee, SooA Lim, SuRak Eo, Jung Soo Yoon, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
Author contributions: Lee DY and Yoon JS designed the research study; Lee DY, Lim S, Eo S and Yoon JS performed the research; Lee DY and Yoon JS analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Informed consent statement: Informed consent for treatment was obtained and attached as a separate file.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jung Soo Yoon, MD, PhD, Doctor, Professor, Surgeon, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, 27, Dongguk-ro, Ilsandong-gu, GoYang 10326, South Korea. crsboys@naver.com
Received: February 6, 2023
Peer-review started: February 6, 2023
First decision: April 26, 2023
Revised: May 2, 2023
Accepted: May 16, 2023
Article in press: May 16, 2023
Published online: June 16, 2023
Processing time: 125 Days and 23.1 Hours
Abstract
BACKGROUND

Hemophilia, an uncommon yet consequential hereditary bleeding disorder, manifests as two clinically indistinguishable forms that hinder the normal functioning of the coagulation cascade. This impairment renders individuals more susceptible to excessive bleeding during significant surgical interventions. Moreover, individuals with severe hemophilia frequently encounter recurring hemarthrosis, resulting in progressive joint destruction and, subsequently, the need for hip and knee replacement surgeries.

CASE SUMMARY

The patient was a 53-year-old man with hemophilia A as the underlying disease and had self-injected factor VIII twice weekly for several decades. He had undergone ankle fusion surgery for recurrent hemarthrosis at the Department of Orthopedic Surgery 1 mo prior and was referred to our department because of skin necrosis after a hematoma at the surgical site. An anterolateral thigh perforator free flap was created after three cycles of factor VIII administration in addition to the concomitant administration of tranexamic acid (TXA) (Transamin 250 mg cap, 1 cap tid, q8h). After the operation, from postoperative days (PODs) 1-5, the factor VIII dose and interval were maintained, and q12h administration was tapered to q24h administration after POD 6. Because the patient’s flap was stable 12 d after the operation, factor VIII administration was tapered to twice a week. At 6 mo follow-up, the patient recovered well without any complications.

CONCLUSION

To the best of our knowledge, there are very few reports of successful free flaps in patients with hemophilia, and none have been reported in patients with hemophilia A. Moreover, there are several reports on the efficacy of TXA in free flaps in general patients; however, there are no case reports of combining factor VIII and TXA in patients with hemophilia. Therefore, we report this case to contribute to future academic research.

Keywords: Free tissue transfer; Anterolateral thigh free flap; Hemophilia A; Hemoarthrosis; Factor VIII; Tranexamic acid; Case report

Core Tip: To our knowledge, there are very few reports of successful free flaps in patients with hemophilia, and none have been reported in patients with hemophilia A. Moreover, there are several reports on tranexamic acid efficacy in free flaps in general patients, but there are no case reports of combining factor VIII and tranexamic acid in hemophilia patients. Therefore, we report this case to contribute to future academic research.