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Circulatory crisis in free toe-to-hand transfer and its management: I. Clinical experience.

On the basis of experience with 226 patients undergoing free toe transfer for reconstruction of the thumb and fingers, circulatory crises during and after surgery are analyzed and classified according to the time of crisis occurrence. Prompt re-exploration is indicated when the crisis occurs within 24 hr postoperative. Crises occurring 48 hr and more postoperative are usually due to vasospasm, and antispasmodic therapy should be instituted. Surgical intervention in these later cases may prove fruitless.