Ischemic toe encountered during harvesting: report of 6 cases

Area of Science:

• Microsurgery
• Vascular Surgery
• Reconstructive Surgery

Background:

• Toe-to-hand transfer is a reconstructive procedure using free tissue transfer.
• Harvesting toe digits requires meticulous dissection of local arterial and venous supply.
• Pre-existing local vessel disease can compromise the viability of the transferred digit.

Observation:

• During 194 toe transfers, 6 cases (4 patients) presented with diseased vessels at the first web space.
• Release of the tourniquet after digit harvest led to acute ischemia in these toes.
• This indicates a critical intraoperative finding necessitating immediate management.

Findings:

• Local arterial disease at the first web space is a significant risk factor for acute ischemia during toe harvesting.
• The observed ischemia occurred immediately upon reperfusion of the lower limb.
• This highlights the vulnerability of the harvested toe to compromised inflow.

Implications:

• Surgeons must be vigilant for signs of local vessel disease during toe harvesting for hand reconstruction.
• Prompt recognition and management are crucial to prevent complete digit loss.
• This experience underscores the importance of thorough vascular assessment in reconstructive microsurgery.