For Patients
Post Transplant Rehabilitation
Postoperative rehabilitation of the transplanted hand is based on extensive experience with replantation. Immediately after transplantation, if there are no surgery related complications, the focus of rehabilitation becomes the restoration of normal form and function and gradual return of patients to activities of daily living, professional life and recreation.
Early mobilization of the transplanted limb is highly encouraged, if possible as early as 1-2 days after surgery. The goals are to minimize edema and stiffness and prevent intrinsic-minus hand and claw deformities.
As part of the early mobilization/bracing program, specialized splints can be utilized that position the hand appropriately with the wrist positioned in slight extension; the metacarpophalangeal joints in 50-70 degrees of flexion; the interphalangeal joints held at 0 degrees and the thumb held in a balance between radial and palmar abduction (by light dynamic extension). It is imperative to reduce the force on the repaired fingers to minimize the risk of tendon rupture. At approximately 1 month after transplant, and depending upon bony healing, wrist and forearm range of motion is initiated within a hand based anti-claw splint. From 2 to 3 months post-surgery, other bracing modalities are introduced including a wrist extension splint that is applied by connecting to an anti-claw splint.
This aids in strengthening of the wrist flexors and extensors by allowing wrist flexion against resistance and assistive active extension. This splint can be used three to four times a day for 15 to 30 minutes. It helps strengthen the repaired tendons and muscles by increasing flexor strength and balancing the antagonistic muscle groups. Light weights are used to isolate and strengthen specific muscle groups such as the wrist flexor and extensors. The anti-claw splint is worn alone when exercises are not being performed. Function at the metacarpal level may be improved by early use of the dynamic crane outrigger splint with a metacarpophalangeal joint extension block. Promoting early protective active motion and blocking metacarpophalangeal joint extension help achieve a hand with an intrinsic-plus posture and coordinated grasping.
