1. Pre-operative (after admission) 1-5 days.
(1) Take temperature, pulse, blood pressure (nurse), complete nursing medical record; admission notification (charge nurse).
(2) Take medical history, physical examination, write major medical record (internist), and complete first medical history (resident).
(3) Arranging laboratory tests for non-emergency surgery (resident): three major routine tests, blood biochemistry, blood type, hepatitis B-6, anti-HIV, anti-HCV, chest X-ray, electrocardiogram.
(4) For those requiring emergency surgery, complete routine blood work, four coagulation tests, three preoperative tests, ECG and chest radiograph if necessary (resident).
(5) Emergency surgical treatment required (chief resident, responsible attending physician) Postoperative anti-infection, hemostasis, rehydration support and other treatment (responsible attending physician), enter the clinical pathway on the day of surgery.
(6) Collect specimens and complete laboratory tests (nurse)
(7) Pre-operative assessment (responsible attending physician, chief physician) For those with poor local conditions and unsuitable for tendon repair surgery, they need to go out of this clinical pathway and improve local conditions first to meet the needs before entering the pre-operative clinical pathway.
(8) Advise patients to abstain from food and water after 12 midnight, prepare skin in the surgical area and tendon donor area, and bathe before bedtime (nurse).
(9) Antibiotic treatment for those who need preoperative prophylactic anti-infection (responsible attending physician)
(10) Pre-operative notification and signing of pre-operative consent form, introduction of surgeon (resident)
(11) Complete the pre-anesthesia assessment and sign the anesthesia consent form, and introduce the anesthesiologist (senior anesthesia responsible attending physician).
2.On the day of surgery.
(1) Complete preoperative injections, leave catheter in place if necessary (nurse), escort patient to the operating room (nurse or internist).
(2) Complete tendon suture surgery (chief resident or responsible attending physician) or tendon graft repair surgery (responsible attending physician, chief physician). After surgery, the affected limb is fixed in a protective position with a cast or brace.
(3) Fasting for 6 hours after surgery to prevent infection, stop bleeding and treat symptoms (resident).
(4) Monitor pulse rate, blood pressure and vital signs, elevate the affected limb (nurse), observe the blood flow of the operated limb, the tightness of external fixation and wound exudation, and observe the nature and flow of drainage if a drainage tube is placed (nurse and resident).
3. Postoperative day 1.
(1) Measure body temperature, pulse, blood pressure, and ask about the injured limb (nurse).
(2) Observe the tightness of the external fixation of the injured limb and the blood movement of the injured limb, check whether there is any sensory disorder, observe the wound dressing exudation and the drainage tube (resident, responsible attending physician).
(3) Prevention of infection, hemostasis, symptomatic treatment (resident, responsible attending physician).
4. Postoperative day 2.
(1) Measure body temperature, pulse shoulder, blood pressure, and ask about the injured limb (nurse).
(2) Observe the tightness of the external fixation of the injured limb and the blood movement of the injured limb, check whether there is any sensory disorder, observe the exudation of the wound dressing and the drainage tube, if there is little drainage, the drainage can be removed (resident, responsible attending physician).
(3) Prevent infection, stop bleeding, and treat symptoms (resident, responsible attending physician).
(4) After the pain is relieved, the injured limb can be lifted and other joints that are not fixed can be moved to reduce edema and promote recovery of limb function (resident).
(5) For those who apply rubber band traction on the injured finger, functional training should be started on the second postoperative day, with 1-2 sets of exercises in the morning, midday and evening, and 10-20 times each for active finger extension (flexion) and passive finger flexion (extension).
5 . Postoperative day 3.
(1) Measure body temperature, pulse shoulder, blood pressure, and ask about the injured limb (nurse).
(2) Observe the tightness of the external fixation of the injured limb and the blood movement of the injured limb, check whether there is any sensory disorder, and observe the wound dressing exudation (resident and responsible attending physician).
(3) Prevent infection, stop bleeding, and treat symptomatically (resident and responsible attending physician).
(4) Continue active and passive functional exercises and limb activities.
6. Postoperative days 4-7.
(1) Measure body temperature, pulse shoulder, blood pressure, and ask about the injured limb (nurse).
(2) Observe the tightness of the external fixation of the injured limb and the blood movement of the injured limb, check whether there is any sensory disorder, observe the wound dressing exudation and drainage tube situation (resident and responsible attending physician).
(3) Prevention of infection, hemostasis, symptomatic treatment (resident, responsible attending physician).
(4) Continue active and passive functional exercise and limb movement.
(5) Discontinue antibiotics 3-5 days after surgery if body temperature is normal and the wound is not infected (resident and responsible attending physician).
(6) Remove stitches 2 weeks after surgery (resident). Continue external fixation of the injured limb after suture removal.
(7) If the injured limb is in good condition and there is no other discomfort, the patient can be hospitalized or discharged for outpatient treatment as appropriate (resident). And inform the follow-up time and precautions after discharge.
7.Discharge outpatient clinic.
(1) External fixation of the affected limb for 3-4 weeks, observation of the blood flow of the injured limb during fixation, regular outpatient review, follow-up of discomfort and guidance of functional exercise (responsible attending physician, chief physician).
(2) Remove stitches 2 weeks after surgery for those discharged from outpatient treatment (nurse, resident physician).
(3) Physiotherapy and functional exercise after removal of external fixation (physiotherapist, responsible attending physician, chief physician).
(4) Chinese herbal medicine treatment may be used as appropriate (responsible attending physician, chief physician).
(5) After 6 months of functional exercise, the injured limb function recovery is unsatisfactory, there are tendon adhesions, surgery can be performed to release the adhesions (responsible attending physician, chief physician).
8. Rehabilitation guidance.
(1) The second day after surgery, wound exudation is reduced, pain can be reduced after the functional training can be started under the protection of rubber bands, 1-2 sets of exercises in the morning, midday and evening, active extension (flexion) of the fingers, passive flexion (extension) of the fingers 10-20 times each. At night, the rubber band can be used without traction to flex the contracture, and those who are in a position to do so can start CPM training under guidance.
(2) Functional exercises of the shoulder and elbow joints can be performed under guidance after the pain is reduced after surgery.
(3) After removal of external fixation of the injured finger, the active and passive extension and flexion functional exercises of the affected finger can be carried out.
(4) According to the situation, various physical therapy methods can be used to promote the swelling of the injured limb to subside and restore the function, including heat therapy, wax therapy, vinegar therapy, etc.
(5) Chinese herbal medicine treatment can be used according to the situation.