Abstract
Introduction We review the benefits of early motion protocols following replantation of a total
right hand amputation at 1 and 2 years after replantation, and provide recommendations
for postoperative management.
Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid
external fixation spanning the forearm and hand. An early active “place-and-hold”
motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal
joint extensors were tethered by the pins, limiting full excursion. This resulted
in stiffness and extensor adhesions that required a staged extensor tenolysis; however,
all joints remained supple. The early motion protocol prevented the need for significant
flexor tenolysis and joint releases.
Results Early motion rehabilitation protocols can produce very successful results in complex
replantation. The enhanced stability afforded by external fixation of the wrist allowed
us to perform aggressive early rehabilitation.
Conclusion This case highlights the benefits of early active motion (limiting the need for complex
joint and flexor tendon releases) and demonstrates the degree of extensor adhesions
caused by even minor extensor tendon tethering. This aggressive rehabilitation approach
can produce excellent range of motion, and likely limit the need for secondary tenolysis
and joint release procedures.
Keywords
hand - wrist - replant - amputation - hand therapy - early motion protocol
