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Axillary plexus blockade in microvascular surgery, a steal phenomenon?
J F Van der Werff1, G Medici, S E Hovius
1Department of Plastic and Reconstructive Surgery, Academic Hospital Dijkzigt, Rotterdam, The Netherlands.
Microsurgery
|January 1, 1995
Summary
Axillary plexus blockade after toe-to-hand transfer caused reduced blood flow in the transplanted toe. Continuous blockade before microvascular completion is suggested for better outcomes in reconstructive surgery.
Area of Science:
- Plastic Surgery
- Anesthesiology
- Vascular Surgery
Background:
- Toe-to-hand transfer is a reconstructive procedure for severe hand injuries.
- Axillary plexus blockade is used for anesthesia and postoperative pain management in upper extremity surgery.
Observation:
- A case report details axillary plexus blockade initiated after microvascular anastomoses in a toe-to-hand transfer.
- Following blockade, vasodilation in the hand and forearm was observed.
- Concurrently, a significant decrease in blood flow to the transplanted toe occurred.
Findings:
- The observed drop in transplanted toe blood flow during axillary plexus blockade suggests a potential complication.
- This phenomenon may be linked to sympathetic nervous system responses or altered vascular dynamics.
- The exact mechanisms require further investigation.
Implications:
- Consider initiating axillary plexus blockade prior to completing microvascular anastomoses in toe-to-hand transfers.
- Continuous postoperative blockade may mitigate adverse vascular effects on the graft.
- This approach could improve the success rate and viability of toe-to-hand replantations.