|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Based on condition of tendons during surgery, the physician will decide when active gliding of tendons under flap can begin. FES can begin 1 week after active range of motion is begun.
When wounds are healed, initiate scar massage.
Light Coban wrapping can begin. Apply dynamic splint. If splint places pressure on flap, consider delaying dynamic splinting until 5 to 6 weeks.
Measure for the Jobst garment that will be given to the patient at 8 weeks. Discontinue use of protective splint.
For functional muscle transfers, initiate functional electrical stimulation for muscle re-education when there is evidence of regeneration.
PROTOCOL VIII: LOWER EXTREMITY MANAGEMENT
This protocol can be used for replantation and microvascular free tissue transfers.
O TO 4 DAYS
Immediately postoperatively, elevate the extremity as instructed by physicians.
5 TO 10 DAYS
General conditioning exercises may begin, excluding the operative sites.
Fabricate splint for immobilization with ankle positioned in 90 degrees of dorsiflexion. Protect insensate areas in the foot. Pad heel and all bony prominences. Do not place straps over flap or vascular anastomosis. Line the splint with sheep-skin (Figs. 42-19, 42-20).
FIG. 42-19. Foot splint for muscle flap located over the anterior aspect of the lower leg.
Patient may be in wheelchair with affected leg elevated.
7 TO 10 DAYS
Begin passive range of motion of adjacent joints to tension only. Therapist must be informed of anastomosis site to avoid stressing the anastomosis.
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