A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage
We present the first reported case of cold urticaria, which was mistaken as congestion status, in a patient undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap coverage. A 53-year-old woman underwent an immediate bilateral breast reconstruction with DIEP flap covera...
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Korean Society for Aesthetic Plastic Surgery
2017-02-01
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doaj-1dbeefe5ce2c44ff91b41f779373f42f2020-11-25T02:18:40ZengKorean Society for Aesthetic Plastic SurgeryArchives of Aesthetic Plastic Surgery2234-08312288-93372017-02-01231495210.14730/aaps.2017.23.1.4945A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap CoverageYoon Jae Lee0Hyun Jun Cho1Deuk Young Oh Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaWe present the first reported case of cold urticaria, which was mistaken as congestion status, in a patient undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap coverage. A 53-year-old woman underwent an immediate bilateral breast reconstruction with DIEP flap coverage. The harvested DIEP flap was wrapped with wet gauze and kept above an ice pack to minimize ischemic damage before flap in-setting to the mastectomy site. After the transfer of the harvested DIEP flap, she had suddenly developed an erythematous and edematous lesion, specifically on the flap. The room temperature was raised and a single dose of steroid and antihistamine was given intravenously. At the first instance, flap congestion was suspected; however, as the rash gradually spread throughout the body, we could deduce that it was cold urticaria. The erythematous rash and whirl resolved soon after receiving medication. Patients with known cold urticaria undergoing surgical procedures require several precautions (e.g., antihistamine, relatively warm operation room) to lessen the risk of severe reaction. Especially in patients with DIEP free flap, the lack of preoperative treatment could result in a pinkish flap due to urticaria, which could be mistaken by the surgeon as a congested flap.http://e-aaps.org/upload/pdf/aaps-23-49.pdfbreastfree tissue flapshyperemiaurticaria |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yoon Jae Lee Hyun Jun Cho Deuk Young Oh |
spellingShingle |
Yoon Jae Lee Hyun Jun Cho Deuk Young Oh A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage Archives of Aesthetic Plastic Surgery breast free tissue flaps hyperemia urticaria |
author_facet |
Yoon Jae Lee Hyun Jun Cho Deuk Young Oh |
author_sort |
Yoon Jae Lee |
title |
A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage |
title_short |
A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage |
title_full |
A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage |
title_fullStr |
A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage |
title_full_unstemmed |
A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage |
title_sort |
case of cold urticaria mistaken as congestion status during breast reconstruction with deep inferior epigastric perforator free flap coverage |
publisher |
Korean Society for Aesthetic Plastic Surgery |
series |
Archives of Aesthetic Plastic Surgery |
issn |
2234-0831 2288-9337 |
publishDate |
2017-02-01 |
description |
We present the first reported case of cold urticaria, which was mistaken as congestion status, in a patient undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap coverage. A 53-year-old woman underwent an immediate bilateral breast reconstruction with DIEP flap coverage. The harvested DIEP flap was wrapped with wet gauze and kept above an ice pack to minimize ischemic damage before flap in-setting to the mastectomy site. After the transfer of the harvested DIEP flap, she had suddenly developed an erythematous and edematous lesion, specifically on the flap. The room temperature was raised and a single dose of steroid and antihistamine was given intravenously. At the first instance, flap congestion was suspected; however, as the rash gradually spread throughout the body, we could deduce that it was cold urticaria. The erythematous rash and whirl resolved soon after receiving medication. Patients with known cold urticaria undergoing surgical procedures require several precautions (e.g., antihistamine, relatively warm operation room) to lessen the risk of severe reaction. Especially in patients with DIEP free flap, the lack of preoperative treatment could result in a pinkish flap due to urticaria, which could be mistaken by the surgeon as a congested flap. |
topic |
breast free tissue flaps hyperemia urticaria |
url |
http://e-aaps.org/upload/pdf/aaps-23-49.pdf |
work_keys_str_mv |
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