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Arterialized Venous Free Flap for Hand Defect Reconstruction Due to Ischemic Steal Syndrome
Rani Septrina1, Putie Hapsari2, Irra Rubianti Widarda1
1Division of Plastic Reconstructive Surgery, Department of Surgery, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
International Medical Case Reports Journal
|March 11, 2025
Summary
Ischemic steal syndrome (ISS) in dialysis patients rarely causes severe hand issues. A unique case involved an infected ulcer treated successfully with a specialized arterialized venous free flap, preserving hand function.
Area of Science:
- Vascular Surgery
- Nephrology
- Reconstructive Microsurgery
Background:
- Ischemic steal syndrome (ISS) is a rare complication in hemodialysis patients.
- It typically does not lead to severe outcomes like gangrene or significant hand dysfunction.
Observation:
- A hemodialysis patient presented with ISS and radial atherosclerosis, manifesting as an infected ulcer.
- The patient underwent treatment using an arterialized venous free flap from the contralateral forearm.
Findings:
- Despite superficial flap necrosis, the non-physiologic flap successfully preserved the patient's hand function.
- Dialysis access was safely re-established just 10 days post-flap surgery.
Implications:
- This case highlights a potential reconstructive option for complex ISS with infected ulcers.
- Early functional recovery and preservation of hand function are achievable even with challenging vascular conditions in dialysis patients.
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