Microvascular Steal Phenomenon in Lower Extremity Reconstruction

Single-stage revascularization and free flap coverage in the treatment of ischemic lower limb lesions

“…For this purpose it seems essential to revascularize even small and isolated distal segments of the native artery [6,20,42]. Until now we have not observed one single case of ongoing necrosis postoperatively, which we attribute to our aggressive revascularization attempts [40]. Even after documented occlusion of the bypass some months after surgery only one out of the three patients developed a new ulcer, the two others kept on ambulating without claudication.…”

Blood flow in free micro-vascular flaps

“…It would seem that during the first postoperative months the free flap promoted indirect revascularization of the ischaemic recipient site (101), thus allowing the foot and the flap itself to survive despite graft occlusion. However, in some cases the free flap has been held responsible for foot necrosis and eventual limb amputation (109,153). The flap may steal blood from the bypass, thus impairing the precarious circulation in the distal part of the lower extremity.…”

“…If, however, vascular resistance is higher in the primary foot circuit than in the parallel flap circuit, then blood flows preferentially through the flap. In patients with a high-resistance distal occlusive disease the free flap may siphon blood off and potentiate distal ischaemic necrosis (153). To avoid this phenomenon, Tukiainen et al (unpublished) placed an adjuvant AV fistula distally to the microanastomosis of the flap to increase the distal outflow of the bypass.…”

Rekonstruktion der vaskulär kompromittierten unteren Extremität – Bericht des Consensus-Workshops im Rahmen der 35. Jahrestagung der DAM 2013 in Deidesheim

“…Abgesehen von der reinen Defektdeckung können Lappenplastiken wohl durch eine erhöhte Flussrate in dem proximal gelegenen Bypass auch dessen Off enheitsrate erhöhen [ 43 ] . Das gelegentlich diskutierte mikrovaskuläre Steal-Phänomen, das zu einer Perfusionsverschlechterung der distal des Lappenanschlusses gelegenen Extremität führen soll, scheint im klinischen Alltag von untergeordneter Bedeutung zu sein [ 44 ] . Ob die Lappenplastik als sogenannter "Nutrient-Flap" sogar die Perfusion des umliegenden Gewebes durch Einsprossen von Gefäßen …”