Free flap “steal” hastening amputation of a revascularized lower limb

Abstract

Complex limb threatening wounds secondary to end-stage atherosclerotic peripheral occlusive disease remain significant challenges that frequently mandate vascularized tissue coverage that can only be achieved with a microsurgical composite tissue transfer. Following or concurrent with limb revascularization, the theoretical risk that such a free flap could divert flow to a comparably lower resistance system of the flap has been previously considered hypothetical. We present a case report where we believe such a “steal syndrome” did occur as suggested by arteriogram, and this adverse phenomenon hastened limb amputation. This possible risk must be carefully explained and accepted by these patients prior to embarking on these complex limb salvage attempts.