title: Microvascular steal phenomenon in lower extremity reconstruction.
abstract: Macrovascular bypass procedures and microvascular free tissue transfer have resulted in dramatic improvements in lower limb salvage. Although vascular steal is a well-documented phenomenon in the surgical literature, there is a paucity of information on its potential impact in microvascular surgery, particularly in relation to lower extremity reconstruction in the elderly patient with peripheral vascular disease. We report three cases of lower extremity reconstruction using microvascular free tissue transfer in which the free flap survived but the distal extremity suffered progressive ischemic necrosis. A retrospective analysis of these cases defines the conditions in which microvascular steal phenomenon may adversely influence lower limb salvage.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Lehigh Valley Hospital, Allentown, PA, USA.
authors.forename: B V
authors.initials: BV
authors.lastname: Sonntag
authors.forename: R X
authors.initials: RX
authors.lastname: Murphy
authors.forename: M A
authors.initials: MA
authors.lastname: Chernofsky
authors.forename: R P
authors.initials: RP
authors.lastname: Chowdary
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000601:surgery*; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D013524:Surgical Flaps / Q000379:methods*