|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Within 24 hours, the uncomplicated microsurgical patient is transferred to the microsurgical ward. There, the experienced nursing staff continues to monitor the replanted or transplanted part and to maintain proper positioning and room temperature. Additionally, they supervise the resumption of diet, initiation of donor site care, maintenance of drains, and postoperative mobilization. A member of the nursing staff joins the physician for morning rounds to clarify plans for medication, mobilization, dressings, and discharge.
Patients and their families are provided with a booklet compiled by the microsurgical nursing staff explaining preoperative studies, surgery, postoperative care, and therapy. The nursing staff also instructs family members in dressing changes and other aspects of home care.
Microsurgery is a technique, not a specialty, and patients who require microsurgical reconstructions often have problems involving a multitude of elements. We have commonly involved specialists in the care of our patients. Orthopedists frequently assist us in the management of traumatic and chronic skeletal defects. They have helped us learn aspects of external fixation and bone plating. The microsurgical laboratory and clinical service of the Davies Medical Center were actually established in 1970 by a neurosurgeon, Dr. Norman Chater,4 and we continue to work closely with neurosurgeons in the management of complex scalp and cranial wounds,5 elevation of full-thickness cranial flaps,6 and complex wound management in spinal cord patients. Oral surgeons and otorhinolaryngologists work with us on complex head and neck cases.
Our internal medicine consultants assist us in the treatment of the underlying and complicating medical problems seen in our patients. They have become adept at tailoring medical management to avoid any pharmacologic insults to replanted tissue. Complex infected wounds 7,8 referred to us for treatment benefit from formal infectious disease consultations. Psychiatric problems that develop in response to injury and prolonged disability are treated by consultant psychiatrists who have attended many of our patients as they have adjusted to their injuries and therapies. Near the time of discharge, the microsurgical patient is seen by a member of our social services department, who evaluates the patient's needs for transportation, home care, and special supplies for wound care.
Our hand therapy unit is staffed by four to six therapists who are trained in either physical or occupational therapy. They regularly attend rounds, clinics, and surgical procedures and tailor each individual's therapy to his or her specific needs.
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