Rehabilitation after amputation (finger) replantation

Early rehabilitation (0-4 weeks): Antispasmodic, anticoagulant and anti-inflammatory treatments are given clinically in the first week after surgery to ensure the survival of the reimplanted limb (finger). Rehabilitation is not intervened at this time. Postoperative 2 to 4 weeks of rehabilitation is to cooperate with the clinical prevention of infection, promote blood circulation, maintain the repair of blood vessels open and accelerate the wound healing of the repair tissue. For example, ultrashort wave electrotherapy: it can promote deep vasodilatation, improve blood circulation, prevent small vein thrombosis and inhibit bacterial growth. It can accelerate the subsidence of edema and control infection. However, for those who fix the fracture with fine steel pins, the dose of ultrashort wave should be strictly controlled in the range of no heat, so as to avoid burns due to overheating of the metal. Ultraviolet irradiation: When the wound is infected with exudate after surgery, localized ultraviolet irradiation can be used. Ultraviolet light has a bactericidal effect, can control the superficial parts of the infection, and promote wound healing. Infrared irradiation: It can make superficial blood vessels dilate, promote the absorption of exudate, and keep the wound dry. Patients with loss of sensation in the limbs should pay attention to preventing burns. Exercise therapy: For the joints that are not braked, the therapist will help the patient to do slight extension and flexion movements, and instruct the patient to practice active movement of the shoulder and elbow joints, so as not to affect the range of motion of other joints due to prolonged braking. Educate patients’ self-protection consciousness: educate patients that the reimplanted limbs (fingers) should be kept warm to avoid vasospasm caused by cold; they should not consume caffeine-containing liquids to avoid vasoconstriction; they should not smoke because nicotine in cigarettes will reduce the oxygen content of the blood, which will jeopardize the blood supply of the reimplanted limbs; they should elevate the injured limbs to keep them in the plane of the heart, so as to reduce the occurrence of oedema. Medium-term rehabilitation (5-8 weeks): Start medium-term rehabilitation after release of hand braking, aiming at controlling edema, preventing joint stiffness and tendon adhesion. Active exercise: Practice finger extension, flexion, hooking and clenching. The movements should be gentle to avoid straining the repaired tissues, and the therapist should guide the patient to perform the exercises correctly. Teach the patient to compensate for the loss of sensation in the injured limb, and use vision to compensate for the loss of skin sensation. Post-rehabilitation (9-12 weeks) At this time, the fracture has healed, and the muscles, nerves and blood vessels have healed firmly. Passive activities and resistance exercises can be used. The main focus is to continue to reduce edema, scar management, active joint mobility exercises, functional activity training (e.g., activities of daily living), sensory retraining, etc. Physical therapy, such as ultrasound therapy and audio therapy, can soften the scar. Before performing active and passive joint exercises, localized wax therapy can soften the scar and joints, which is conducive to the functional exercise of the injured hand. Joint mobility exercises: Active movements of the joints in all directions. Movements should be smooth and gentle, and then moderate force should be applied when the maximum movement is reached, so that the joint area will feel tense or mild soreness. Passive exercise: passive stretching activities: this method of stretching stronger, but the technique should be gentle, in order to cause the joints to have a sense of tension or soreness to the extent. Do not use violence or cause significant pain, so as not to cause new trauma. Splints: there are two types of static and power splints. The purpose of using splints is to correct and prevent deformity and to improve function. Muscle strength and endurance exercises can be graded from light to heavy resistance training. The principle of promoting muscle recovery is to contract the muscle to its maximum capacity to induce moderate fatigue, followed by appropriate rest to allow the muscle to recover and develop its form and function in recovery and subsequent overload. When the joint mobility and muscle strength have been recovered to a certain extent, various daily life activities and functional activities can be started in time.12 Rehabilitation of ischemic myoclonus of the forearmAccording to the differences in rehabilitation and prognosis, we classify ischemic myoclonus into three types: light type: deep (or) superficial flexor contracture of the finger, inability to extend the wrist and the finger at the same time, and only when the wrist is flexed, it is able to extend the finger either actively or passively, or in the position of flexion, it is able to extend the wrist either actively or passively, and it is able to extend the wrist either actively or passively, and it is able to extend the wrist either actively or passively when it is flexed. The prognosis is good because there is no skin sensory disorder and the patient can extend the wrist actively or passively when the wrist is flexed or when the wrist is in the flexed position. Intermediate type: contracture of deep and superficial finger flexors, bunion flexor, wrist flexor, pronator teres, or intrinsic muscle contracture, accompanied by cutaneous sensory disturbances in the sensory distribution area of the median nerve. Severe form: contracture of forearm flexors, extensors and intrinsic hand muscles, loss of movement and sensation, generally poor prognosis.