Vascular compromise occurs in 10-15% of toe transfers.7 The most common vascular complication is vasospasm. This usually occurs in the first few days postop-eratively. If removing skin stitches and using heat lamps and/or vasodilators do not relieve the vasospasm within an hour, the anastomosis should be re-explored. Most transfers can be saLVAged, however approximately 3.5-5% go on to fail. Venous thrombosis is less common, but also prompts re-exploration. Venous thrombosis is likely the result of poor surgical technique or hematoma.
Partial necrosis of thin toe skin flaps is common. If neurovascular structures or tendons are exposed, early intervention is necessary to prevent desiccation using local tissue transfers or skin grafts.
Free toe transfer is subject to the same postoperative complication of infection. Perioperative prophylactic antibiotics, usually cephalosporins, are recommended. If leeches are used for venous congestion, antibiotic coverage of Aromonas hydrophilia is warranted.
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