|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Pulsed ultrasound to sensate areas begins if adhesions are present.
Measure for Jobst glove that will be given to the patient at 8 weeks.
6 TO 8 WEEKS
Discontinue use of protective splint.
Begin light, resistive activities and progressive strengthening exercises as tolerated. When patient perceives protective sensation, begin sensory re-education program.
8 TO 12 WEEKS
Progressive athletic activities for lower extremities are introduced, as well as graded running.
PROTOCOL VI: SECOND-TOE-TO-HAND TRANSFERS
Immediately postoperatively, elevate on pillows. Lower extremity is elevated on 5 pillows. Use a heating pad to keep the upper extremity warm.
The first postoperative dressing change is performed by the physician. After this, the therapist is responsible for twice-daily dressing changes and monitoring of wounds during treatment session.
Begin passive range-of-motion of unaffected digits and active and passive range-of-motion of thumb.
DAY 4 TO 10
Dorsal protective splint is fabricated in postoperative position with wrist in neutral, unless presence of flap or anastomosis on the dorsal surface warrants a volar splint.
Patient may be in wheelchair as tolerated, with donor foot wrapped in an Ace bandage and elevated.
Review x rays, consult with physician, and plan treatment strategy for early motion. These cases are often more complex because of the various locations for transplanted digits, type of fixation, location of anastomosis, presence of flaps or skin grafts, and status of wound healing.
DAY 10 TO 14
Begin EPM I as described in DIGIT REPLANT PROTOCOL.
DAY 14 TO 18
Begin passive EPM II as described in DIGIT REPLANT PROTOCOL. Begin dangling protocol for lower extremity as described in lower extremity microsurgery section unless wound healing is delayed.
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