Drains are maintained until significant drainage ceases.

The patient must be kept in a warm room, free from drafts and changes of temperature, to encourage vasodilation and prevent vasospasm. The area of injury is covered with a heating pad over a sterile towel. Smoking by the patient or anyone visiting the patient is absolutely forbidden. Continuous nasal 02 is beneficial, particularly with a decreasing hematocrit.

Psychologic preparation and care of the patient are also important, particularly for patients who may have sustained severe, mutilating injuries. The pyschologic impact, however, does not always correlate with the extent of physical injury. Regardless of the injury, sympathetic and understanding treatment helps the patient cope with his problem and is an important factor in recovery and rehabilitation after surgery.

Discharge planning involves the coordination of postoperative physical therapy, nursing, and homemaking care, and it is individualized for each patient (Fig. 35-3) Additionally, some patients live at a great distance from the microsurgical center, and medical management is shared with a local physician to reduce the need for long return trips.

DAY 1

1. Admit to Microsurgery Service.
2. Allergies-None
3. Vital signs-routine
4. Bed rest
5. Diagnosis: Open fracture left tibia/fibula
6. Force fluids, NPO after midnight tonight for angiogram tomorrow in am
7. Consent for angiogram, left leg, with runoff.
8. CBC, SMA6, UA, PT/PTT, T & C 2 units PC.
9. Wet-to-dry dressing with normal saline q6h*
10. Tylenol #3, 2 tabs PO q4h PRN
11. Halcion 0.25 mg PO qhs PRN
12. No smoking
13. ASA 250 mg PO if not started pre-op.

* Assumes granulating wound; otherwise debridement surgery would be performed first and flap surgery done later.

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