Postoperative monitoring of pediatric toe-to-hand transfers with differential pulse oximetry

Twenty-three toe-to-hand transfers performed in 21 children were monitored after surgery using differential pulse oximetry for 4 to 12 days. Pulse rat e recorded by the pulse oximetry monitored the patency of the arterial anas tomosis, whereas oxygen saturation (SaO(2)) corresponded to the patency of the venous anastomosis; these were both compared with the systemic pulse ra te and oxygen saturation recorded by a second control pulse oximeter probe attached to a contralateral finger or toe. All 23 toe transfers were ultima tely successful, but 2 required re-exploration for anastomotic problems det ected by the pulse oximeter. Based on this experience, the following criter ia have been developed far the nursing and junior medical staff: if the art erial pulse of the toe transfer is lost completely or if the pulse rate dif fers significantly from the systemic pulse rare, measured by the second con trol pulse oximeter, thrombosis of the arterial anastomosis should be suspe cted. If the oxygen saturation of the toe transfer decreases below the oxyg en saturation measured by the control pulse oximeter and this differential is sustained over a period of time, thrombosis of the venous anastomosis sh ould be suspected. Differential pulse oximetry appears to be superior to te mperature monitoring and percutaneous and laser Doppler monitoring and prov ides the most simple and continuous technique of noninvasive postoperative monitoring of toe-to-hand transfers in children requiring reconstruction of traumatic or congenital deformities. Copyright (C) 2001 by the American So ciety for Surgery of the Hand.