Postoperative care

As in any free tissue transplant, it is important to optimize circulation during the early

Fig. 11. Position of the extremity on completion of the transplant.

postoperative phase. Thus, a high circulating blood volume with a stable blood pressure and hematocrit at an optimum viscosity for tissue perfusion is essential. The limb should be placed in a slightly elevated position, and the patient should be gradually mobilized from bedrest to a chair to ambulation over a period of several days.

As previously outlined in this article, the rehabilitative process is essential for the success of the operation. The collaborative efforts of the patient, physical therapist, occupational therapist, and surgeon are needed. For the first 3 weeks after surgery, the extremity is splinted in such a position as to relax the tendon repairs distally and the site of muscle belly fixation proximally. After this, there is a second 3-week period during which gradual passive exercises are performed. Initially, the fingers and wrist are brought into full extension, with the elbow flexed. The elbow is then fully extended, with the wrist and fingers fully flexed. Then, during a 3-three week period, the fingers, wrist, and elbow are simultaneously extended. In this manner, full passive mobilization has been accomplished after 9 weeks. Hopefully, at this stage, the beginnings of active muscle contraction become evident. When active muscle contraction begins, it is critical to start active exercises to gain excursion and minimize adhesions, particularly distally. As the muscular contraction increases, the digital and thumb excursion should also increase. Once possible, active resisted exercises should be started. This further increases excursion and particularly increases strength (Fig. 12). The entire rehabilitation program may not plateau, and thus may be of ongoing benefit for up to 1.5 years. Patient and family involvement is essential.

Fig. 12. (A) Preoperative view with limited finger flexion. (B) Postoperative view with full wrist and finger extension: volar (left) and dorsal (right) views. (C) Postoperative view with excellent finger and thumb flexion: volar (left) and dorsal (right) views. (D) Postoperative view demonstrates grip.

Fig. 12. (A) Preoperative view with limited finger flexion. (B) Postoperative view with full wrist and finger extension: volar (left) and dorsal (right) views. (C) Postoperative view with excellent finger and thumb flexion: volar (left) and dorsal (right) views. (D) Postoperative view demonstrates grip.

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