Paediatric microvascular surgery: anaesthetic experience of 27 toe to hand transfers

Summary Free vascularized compound toe transfer to the hand offers the best possibility of restoring maximal function in the treatment of children afflicted by congenital or traumatic deformities of the hand. The surgery often involves multistaged operations and protracted periods of hospitalization in otherwise healthy children. We describe our experience in the first 20 children who underwent 27 free toe to hand transfers for a variety of conditions with a 100% successful transfer survival. The perioperative technique was directed towards controlling fear, pain, temperature and circulating volume in the child, as these were thought clinically to be the most important vasospastic stimuli. Continuous brachial plexus anaesthesia was used in all cases. The use of preoperative psychological counselling and of a dedicated high dependency unit for continuing postoperative care is emphasized. Complications resulting from prolonged tourniquet times are also discussed.