Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 42:
Hand 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 session.

Dorsal protective splint is fabricated in postoperative position with wrist at neutral. The presence of flap or anastomosis on the dorsal surface may warrant a volar splint.

Gentle passive CMC range of motion begins as soon a anticoagulant therapy is discontinued. From this day on, the patient is seen until discharged.

Begin gentle active and passive wrist flexion to tension and extension to neutral.

Uninvolved digits begin active and passive range of motion.

If vascular status of transferred digit remains stable during and after several sessions of CMC passive range of motion, begin active CMC motion.

Patient may be in a wheelchair as tolerated, with donor foot wrapped in an Ace bandage and elevated.

DAY 10 TO 14

Begin gentle passive MP (if free) and IP range of motion. The wrist remains in neutral position. Protect positioning of thumb to avoid full composite flexion or extension until 5

  weeks postoperatively.

DAY 18 TO 21

Begin active MP (if free) and IP range of motion in protected position. Begin protocol for dangling lower extremity as described in protocol for lower extremity microsurgery (Protocol VIII) unless wound healing is delayed.


If pin has been removed from MCP joint, begin isolated active and passive range of motion. With MCP joint reconstruction, care is taken to avoid lateral motion secondary to collateral ligament reconstruction.


Gradual active and passive wrist extension past neutral is begun and continued as tolerated. Scar massage is begun, as well as light Coban wrap and retrograde massage for edema control.


Active and passive composite thumb and wrist motion begins. FES is initiated. Blocking splint is fabricated to improve isolated joint motion. Dynamic splinting with light tension may begin if bony union is stable. Supervised light functional activities (sponges, pegs) are started.

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