|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Begin light resistive activities and progressive strengthening exercises as tolerated.
When patient perceives protective sensation, begin sensory re-education program.
PROTOCOL II: THUMB REPLANTATION
Immediately postoperatively, elevate on pillows, taking care that the thumb is not in the dependent position. A heating pad is used to keep the extremity warm.
DAY 4 TO 10
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. Fabricate dorsal protective splint in postoperative position with wrist at neutral (Fig. 42-15). Begin gentle passive CMC range of motion once anticoagulant therapy is discontinued. Begin gentle active and passive wrist flexion to tension and extension to neutral. Begin active and passive uninvolved finger range of motion.
FIG. 42-15. Dorsal protective thumb splint. The fingers are free.
| Initiate active CMC motion.
Begin gentle passive MP and IP range of motion if joints are free from fixation. The wrist remains in neutral position.
Continue to protect positioning of thumb to avoid full composite flexion or extension until 5 weeks postop.
DAY 14 T0 21
Begin active MP and IP range of motion in protected position.
Continue EPM I and EPM II through 5 weeks. Begin scar massage.
4 TO 5 WEEKS
Gradual active and passive wrist extension past neutral is begun and continued as tolerated. FES initiated if necessary. May begin light Coban wrap and/or retrograde massage.
5 TO 6 WEEKS
Active and passive composite thumb and wrist motion is begun. Blocking splint fabricated to improve isolated joint motion. Dynamic splinting with light tension if fractures are stable. Supervised light functional activities (sponges, pegs) are begun.
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