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Microvascular steal phenomenon in lower extremity reconstruction
B V Sonntag1, R X Murphy, M A Chernofsky
1Department of Surgery, Division of Plastic Surgery, Lehigh Valley Hospital, Allentown, PA, USA.
Annals of Plastic Surgery
|March 1, 1995
Summary
Vascular steal can compromise lower limb salvage after microvascular free tissue transfer, especially in elderly patients with peripheral vascular disease. This phenomenon, where blood is diverted from the extremity to the flap, can lead to tissue death despite flap survival.
Area of Science:
- Vascular Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Macrovascular bypass and microvascular free tissue transfer significantly improve lower limb salvage rates.
- Vascular steal is a known complication, but its impact on microvascular surgery, particularly in elderly patients with peripheral vascular disease (PVD), is under-documented.
Observation:
- Three cases of lower extremity reconstruction using microvascular free tissue transfer are presented.
- In these cases, the free flap survived, but the distal extremity experienced progressive ischemic necrosis.
Findings:
- Microvascular steal phenomenon can occur even when the free flap is viable.
- This steal can lead to distal ischemia and necrosis, jeopardizing lower limb salvage.
- Retrospective analysis identified specific conditions predisposing to this adverse outcome in elderly PVD patients.
Implications:
- Highlights the critical need to consider and manage the vascular steal phenomenon in microvascular lower extremity reconstruction.
- Suggests that careful patient selection and surgical technique are crucial to prevent distal ischemia in high-risk populations.
- Emphasizes the importance of monitoring distal perfusion post-operatively to ensure successful limb salvage.