Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 42:
Hand Therapy
  Microsurgical procedures, regarded not long ago as rare and sensational individual cases, are now widely performed with reliable results. In reports from centers with experienced microsurgical teams, success rates for digit replants exceed 85%,1 microvascular flap transfer success rates exceed 95%,2 and elective microvascular toe transfers almost always survive.3,4 This level of technical success has led to more critical evaluation of functional success. It is in the area of functional success that hand therapy has come to play an enormously important role. Increasingly, the hand therapist has become the individual in the microsurgical team who is primarily responsible for the day-to-day wound care, splinting, mobilization, functional and vocational evaluation, and preparation for secondary procedures.

In our unit, hand therapists are involved in the postoperative care of all elective and emergency microsurgical patients. Postoperative therapy can be divided into early, intermediate, and late phases of care, and specific requirements for each type of procedure as well as some general principles must be recognized. Specific protocols for therapy of upper extremity replantation, toe transfers, and microvascular flap transfers are appended to this chapter.

Early Care (Postoperative Hospitalization)


Postoperatively, all microsurgical patients are seen by therapists and the physicians on team rounds. Directions for postoperative dressings, splints, and therapy are discussed and then formulated into a therapy plan.

For replant patients, the initial dressing changes are performed by the physicians. All dressings are bulky and loose to avoid constriction (Figs. 42-1 to 42-3). Once the replant appears successful and anticoagulants are discontinued, dressings, splints, and mobilization protocols are managed by therapists (Protocols I through IV). Home wound management and outpatient therapy are arranged during this period. The exact details of the operation performed must be clearly communicated to the therapist so that postoperative planning can be individually tailored.

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