|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
DAY 18 TO 21
Begin active EPM II.
Gradual active and passive wrist extension past neutral is begun and continued as tolerated. Consider adding active EPM II to home program. Scar massage and, if needed, light Coban wrapping to palm only for edema control.
5 TO 6 WEEKS
Begin passive and active composite wrist and finger flexion and extension. Begin dynamic splinting as indicated if bony union is stable. Begin FES. Begin blocking exercises to isolate joint motion. Begin static volar extension pan splinting at night when indicated. Begin supervised light functional activities (sponges, pegs). Begin pulsed ultrasound to sensate areas if adhesions are present.
6 TO 8 WEEKS
Measure for Jobst glove to be issued at 8 weeks. Continue light functional activities. 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.
PROTOCOL VII: FREE TISSUE TRANSFERS
Immediately postoperatively, with physician instructions, elevate the operated extremity on pillows.
DAY 3 TO 7
Protective positioning splint is frequently fabricated early in the postoperative period to improve joint positioning and facilitate dressing changes.
DAY 5 TO 7
When vascular status has stabilized and anticoagulant therapy has been discontinued, begin passive range of motion of associated joints if motion will not affect flap inset or associated repairs (tendons, nerves, etc.) If a vascular anastomosis is at a joint, passive range of motion may be delayed up to 3 weeks.
The type of dressing is determined by the physician. Bulkiness should be consistent to ensure proper fit of splint.
|Ch. 42 Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16|