Axillary plexus blockade in microvascular surgery, a steal phenomenon?

A case report is presented of an axillary plexus blockade following a second toe-to-hand transfer. After completion of the microvascular anastomoses and restoration of blood flow to the transplanted toe, the axillary plexus blockade was started. Together with the vasodilation of the hand and forearm there was a marked drop in blood flow in the transplanted toe. Possible explanations for this phenomenon are considered. We suggest starting axillary plexus blockade before completion of microvascular anastomoses and maintaining a continuous postoperative blockade.