Abstract
A 47-year-old female presented with an intractable ulcer caused by external decompression during treatment of a massive stroke in the right middle cerebral artery. On the first admission to the previous hospital, a baseline platelet count of > 10 × 105/μL and JAK2V617F mutation were observed, which revealed untreated essential thrombocythemia. The patient underwent cranioplasty with a free anterolateral thigh flap after external decompression for cerebral swelling, which was unsuccessful due to suspected thrombosis and infection. An intractable skin ulcer gradually formed and deteriorated in the right temporal region, leading to a referral to our department for further surgical treatment. We performed a free latissimus dorsi flap after cytoreduction therapy with hydroxyurea to reduce platelet counts below 4.0 × 105/μL, while closely monitoring side effects under hematologist supervision. The flap was engrafted without any postoperative complications. Thus, the involvement of a hematologist and preoperative management with cytoreduction therapy should be considered in essential thrombocythemia patients undergoing reconstructive surgery.
(a) Debridement of the ulcer. Grafted skin and ulcer were debrided. (b) Harvested latissimus dorsi flap. The sliding-shaped latissimus dorsi flap was designed and harvested. (c) Grafted free latissimus dorsi flap. The flap was grafted to the defect elliptically on the left temporal region. (d) Engrafted free latissimus dorsi flap. No postoperative complications have been observed.
