FIG. 42-08. Ace bandage is wrapped from toes to knee in a figure-eight pattern (to avoid occlusion).

FIG. 42-09. Wrap completed.

FIG. 42-10. Coban is wrapped distal to proximally in a figure-eight pattern (to avoid occlusion).

Protocols

PROTOCOL I: DIGIT REPLANTATION

DAY O T0 4

Immediately postoperatively, elevate the injured extremity on pillows, taking care that fingertips are not in the dependent position (Fig. 42-11). A heating pad is used to keep the extremity warm (Fig. 42-12).

If postoperative dressing and plaster cast are taken down early (because of excessive drainage, constriction, or poor positioning), a volar resting splint is made. The wrist is positioned in neutral and the fingers are supported to encourage MP flexion and IP extension. Care is taken to move the fingers as little as possible. Straps are placed on the forearm only.

FIG. 42-11. Hand and arm are elevated above the heart. Fingertips are not in a dependent position.

FIG. 42-12. The hand is kept warm with a heating pad.

DAY 4 TO 10

These steps are taken after discontinuation of anticoagulant therapy.

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 sessions.

A dorsal protective splint is fabricated to position the wrist at neutral and fingers in the maximum MP flexion and IP extension that can be easily achieved in this early stage (Figs. 42-13, 42-14). The splint is serially adjusted as gains are made in therapy. Straps are soft and padded to distribute pressure evenly.

Early protective motion I (EPM I) is begun. The patient actively flexes the wrist, allowing the tenodesis to extend the MP and IP joints. The patient actively extends the wrist to neutral (taking care that the extrinsic digital extensors are not contracting to assist), with simultaneous gentle passive MP joint flexion.

next page...