Postoperative care

Early mobilization remains a crucial component of our postoperative protocol. Volar injuries to the hand involving the flexor tendons are managed with dynamic splinting as proposed by Kleinert [13]. Isolated extensor injuries are treated with an outrigger apparatus, and assisted active range of motion is begun within 72 hours of surgery once the drains have been removed [9,10]. Within 3 weeks and after significant edema has subsided, custom-fitted orthotic braces are designed and tailored to a predetermined range of motion. Patients whose injuries result in loss of intrinsic function are splinted with the metacarpo-phalangeal joints in a flexed position, while leaving the interphalangeal joints free to extend. Hand or transmetacarpal amputations are treated with a metacarpophalangeal block and an extensor outrigger.

Degloved Entire Hand
Fig. 17. (A-C) Resurfacing of a dorsal hand degloving injury with a free groin flap.
Degloving Injury Hand
Fig. 18. Extensive circumferential degloving injury of the entire forearm (A) resurfaced with a chimeric latissimus dorsi and scapular flap based on the subscapular system (B-D).
Rectus Abdominis Muscle Flap
Fig. 19. Complex volar wrist and hand wound with exposure of flexor tendons and neurovascular bundles (A) resurfaced with a rectus abdominis muscle flap (B).

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