3 WEEKS

When wounds are healed, initiate scar massage.

4 WEEKS

Light Coban wrapping can begin. Apply dynamic splint. If splint places pressure on flap, consider delaying dynamic splinting until 5 to 6 weeks.

6 WEEKS

Measure for the Jobst garment that will be given to the patient at 8 weeks. Discontinue use of protective splint.

8 WEEKS

For functional muscle transfers, initiate functional electrical stimulation for muscle re-education when there is evidence of regeneration.

PROTOCOL VIII: LOWER EXTREMITY MANAGEMENT

This protocol can be used for replantation and microvascular free tissue transfers.

O TO 4 DAYS

Immediately postoperatively, elevate the extremity as instructed by physicians.

5 TO 10 DAYS

General conditioning exercises may begin, excluding the operative sites.

Fabricate splint for immobilization with ankle positioned in 90 degrees of dorsiflexion. Protect insensate areas in the foot. Pad heel and all bony prominences. Do not place straps over flap or vascular anastomosis. Line the splint with sheep-skin (Figs. 42-19, 42-20).

FIG. 42-19. Foot splint for muscle flap located over the anterior aspect of the lower leg.

FIG. 42-20. Foot splint for patient with muscle flap over ball of foot.

7 DAYS

Patient may be in wheelchair with affected leg elevated.

7 TO 10 DAYS

Begin passive range of motion of adjacent joints to tension only. Therapist must be informed of anastomosis site to avoid stressing the anastomosis.

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