|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
DAY 7 TO 14
Depending on when vascular status has stabilized and anticoagulant therapy has been discontinued, begin passive range of motion to wrist, fingers, and thumb.
DAY 14 TO 21
Begin active assisted and passive range of motion to shoulder, avoiding stress to any open wounds or repair sites. All shoulder motion should be approved by the physician.
Begin active range of motion to wrist, fingers, and thumb. Begin passive and active elbow motion if joint is free from fixation. All motion must be cleared by the physician. Gains should be gradual and may be restricted to 5 degrees per session to prevent stress on repairs that cross this joint. Edema reduction is often the primary goal at this stage; begin Coban wrap and retrograde massage to fingers and hand. Provide sling or fabricate arm support to prevent dependent position during ambulation.
Begin splinting to prevent flexion or extension deformities. Begin dynamic splinting to improve passive range of motion of hand as needed.
5 TO 6 WEEKS
Ultrasound to sensate areas if adhesions or joint restrictions are present. Begin functional activities.
6 TO 8 WEEKS
Discontinue use of protective splint. Initiate elastomero to form scar pads. As nerve regeneration occurs, therapist can initiate functional electrical stimulation to strengthen weak muscles. Begin progressive resistive exercise to weak muscles.
Goal from 8 weeks on is to maintain range of motion and maintain and improve strength of existing musculature as nerve regeneration occurs.
PROTOCOL V: GREAT TOE-TO-THUMB TRANSFER
Immediately postoperatively, elevate the upper and lower extremities. Use a heating pad to keep the upper extremity warm.
DAY 4 TO 10
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