Microvascular Steal Syndrome in the Pedal Bypass and Free Muscle Transfer?

Abstract

The last decade has seen great improvement in the surgical treatment of diabetic foot syndrome. Today it is common knowledge that the critically ischemic diabetic foot can be successfully revascularised. Several papers have been published detailing excellent results with the combined procedure of arterial bypass with free muscle transfer. The procedure appears promising for limb salvage in patients with extensive gangrene and infection in the limb, however this complicated operation is not able to salvage the limb in cases. The patient presented in this study underwent a pedal bypass and free muscle transfer operation on both limbs in a 13-month period. We successfully saved only one lower limb despite the fact that we performed the same procedure on both extremities. Progressive foot gangrene developed despite even though the bypass and vital flap was functioning properly. The cause of the foot gangrene development was researched. The main reason for the progressive ischemia development is believed to be the “Steal Phenomenon” an infrequent complication confirmed by the literature reviewed. Case Report