Arterialized Venous Free Flap for Hand Defect Reconstruction Due to Ischemic Steal Syndrome

Ischemic steal syndrome (ISS) occurs in hemodialysis patients. Hence, it rarely becomes gangrene or disrupts hand function. We reported a patient with an ISS and radial atherosclerosis that presented with infected ulcer. The patient was treated with arterialized venous free flap from the contralateral forearm. Dialysis access can be used as early as 10 days after the flap. The report also describes the long-term functional follow-up after reconstruction. Although there was superficial flap necrosis, this non-physiologic flap can preserve the patient's hand function.