|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Active and passive range of motion of uninvolved digits can be started.
FIG. 42-13. Dorsal protective splint for digital replantation. Dorsal view.
DAY 10 TO 14
Continue EPM I. Begin passive early protective motion II (EPM III. Motion is initiated to IP joints that are free of fixation as follows:
I. Claw position (intrinsic minus position)
II. Table top (intrinsic plus position).
DAY 14 T0 21
Begin active EPM II within the guidelines outlined for passive EPM II.
3 TO 4 WEEKS
Continue EPM I and EPM II through 5 weeks. Begin scar massage. In cases of extreme edema, light Coban wrap and/or retrograde massage may be initiated.
4 TO 5 WEEKS
Gradual active and passive wrist extension past neutral is started and continued as tolerated. May begin functional electrical stimulation (FES). May begin light Coban wrap and/or retrograde massage.
5 TO 6 WEEKS
Begin composite wrist and finger flexion and extension, passive and active. Begin dynamic splinting as indicated if fractures are stable. Begin blocking exercises to isolate joint motion. Begin differential tendon gliding exercises. 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
Discontinue use of protective splint. Continue light functional activities.
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