Paleness represents slow capillary refill and arterial thrombosis and vasospasm of arterial inflow. A swollen and blue fingertip with increased capillary return indicates venous congestion caused by constricted dressings or thrombosis of the venous anastomoses. Monitoring of the digit is critically important because thrombosis at the vascular anastomoses is the leading cause of microsurgery failure (Beasley, Aston, Bartlett, Gurtner, & Spear, 2007; Beris et al., 2009).