Summary
A patient with Waldenström's Macroglobulinemia (WM) underwent bilateral radical vulvectomy followed by one stage reconstruction of the vulva using bilateral supero-medial thigh skin flaps. Necrosis of the distal portion of the left flap, observed post surgery, could be attributed to three findings associated with WM : IgM macroglobulin, cryoprecipitation and protein-protein interaction. Both careful pre-operative assessment of the patient's haematorheologic profile and consideration of ways of decreasing blood viscosity may be helpful in improving flap survival. Monitoring of body temperature and warming the flap during surgery is considered important. Infusion with low molecular weight dextran intra-operatively and post surgery may also help in limiting thrombosis within the flap.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Angel MF, Narayanan K, Swartz WM (1985) The etiologic role of free radicals to hematoma-induced flap necrosis. Plast Reconstr Surg 77:795
Earle AS, Fratianne RB, Nunez FD (1974) The relationship of hematocrit levels to skin flap survival in the dog. Plast Reconstr Surg 54:341
Fudenberg HH, Sites DP, Caldwell JL (1980) Basic and clinical immunology. Lange Medical Publications, Los Antos, CA
Goulian D (1969) The use of bromophenol blue in the assay of Rheomacrodex effects of flap viability. Plast Reconstr Surg 39:227
Hanke CW, Steck WD, Bergfeld WF (1980) Cutaneous macroglobulinosis. Arch Dermatol 116:575
Har-Shai Y, Hirshowitz B, Marcovich A (1984) Blood supply and innervation of the supermedial thigh flap employed in one-stage reconstruction of the scrotum and vulva — an anatomical study. Ann Plast Surg 13:504
Hirshowitz B, Moscona R, Kaufman T (1980) One-stage reconstruction of the scrotum following Fournier's Syndrome, using a probable arterial flap. Plast Reconstr Surg 66:608
Hirshowitz B, Peretz BA (1982) Bilateral supero-medial thigh flaps for primary reconstruction of scrotum and vulva. Ann Plast Surg 8:390
LeVeen HH, Ip M, Ahmed N (1980) Lowering blood viscosity to overcome vascular resistance. Surg Gynecol Obstet 150:139
MacKenzie MR, Lee TK (1977) Blood viscosity in Waldenström's Macroglobulinemia. Blood 49:507
McFarlane RM, Laird JJ, Lamon R (1968) Evaluation of Dextran and DMSO to prevent necrosis in experimental pedicle flaps. Plast Reconstr Surg 41:64
Morley-Forster PK (1986) Unintentional hypothermia in the operating room. Can Anaesth Soc J 33:516
Rosberg B, Wulff K (1979) Regional blood flow in normovolaemic and hypovolaemic haemodilution. An experimental study. Br J Anaesth 51:423
Ruberg RL, Falcone RE (1978) Effect of protein depletion on the surviving length in experimental skin flaps. Plast Reconstr Surg 61:581
Waldenström J (1944) Incipient myelomatosis or “essential” hyperglobulinemia with fibrinogenopenia: A new syndrome? Acta Med Scand 117:216
Wintrobe MM, Lee GR, Boggs DR (1981) Clinical hematology. Lea and Febiger, Philadelphia
Wright DJ, Jenkins DE (1970) Simplified method for estimation of serum and plasma viscosity in multiple myeloma and related disorders. Blood 36:516
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Har-Shai, Y., Kaufman, T., Peretz, B.A. et al. Waldenström's Macroglobulinemia: A possible cause for impairment of skin flap circulation. Eur J Plast Surg 10, 111–114 (1987). https://doi.org/10.1007/BF00294473
Issue Date:
DOI: https://doi.org/10.1007/BF00294473