Replantation revascularization: general notes therapy

Unless specifically outlined by the replantation therapy protocol, therapy is often dictated by individual protocols for fracture, tendon injury, nerve injury, or skin graft as necessary. Mobilization is restricted by vascular repairs only when there have been postoperative vascular problems or wound healing problems over the vascular repairs. In that case, only the joints proximal and distal to the unfavorable wound closure should be immobilized until the wounds are healed.

NOTE:

When open wounds are present whirlpools may be used for debridement as needed.

Close monitoring for obstruction of venous return or arterial flow is very important. Adaptations of splints may be necessary for a winder area of contact so as not to obstruct circulation.

Possible Complications

Prolonged immobilization and/or possible bone grafting may be necessary due to delayed union or non-union of fractures.

Joint damage and contractures may necessitate capsulotomy/capsulectomy and/or joint arthroplasty.

Flexion/Extension tendon adhesion/rupture may necessitate further reconstructive procedures as needed.

Insensate digits may be non-functional or easily injured. The development of neuromas may cause severe pain problems.

NOTE:

Instructions/precautions against excessive heat, cold, and exposure to sharp objects is essential when dealing with insensate digits.

Recovery following replantation is often very prolonged and it is essential to have the patient return to one handed work as soon as possible, as recovery is often incomplete and stabilization may take as long or longer than a full year. Also, it is possible that the patient may need revisionary surgery over the year. The patient should be warned about long term problems with cold intolerance as well as joint stiffness.

A prolonged phase of psychological adjustment is common with replantation as with any amputation, and it is common to have troublesome nightmares or flashbacks for months following the initial injury. The patient must be counselled about this difficulty as well.

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