gms | German Medical Science

Clinical issue/s: The survivor is a 23 year old female who sustained complete amputation of right upper limb at above elbow and partial amputation of left digit with subsequent fractures and tendon lacerations due to domestic abuse. It became a dilemma as to where survivor should be discharged to as there are strict criteria for admission in a private insurance world. Moral ethics played a huge role in advocating for the survivor given her post-surgical medical and functional needs. Stereotypes of subacute rehabilitation facility and skill level of the therapists working in a subacute facility treating this complex condition were raised.

Clinical reasoning: The ultimate success of a replanted limb is the patient's ability to use that limb for ADLs. Hand surgeons must consider not only the surgical technique but the post-surgical interventions. Successful functional use of the replanted limb is dependent on post-operative management. Cooperation among the patient, the hand surgeon, and the rehabilitation team is crucial for a successful functional outcome.

Innovative, analytical or new approach: Treating hand therapist collaborated with rehab team of a subacute facility to provide best hand therapy. Hand therapist co-treated with therapist at subacute facility with the patient, providing hands-on tutorial on treatment techniques. This enabled the patient to regain function in her bilateral upper extremity, and return to performing her ADLs and participation in the community.

Contribution to advancing HT practice: We must consider and advocate for our patients during discharge planning. It is a known stereotype that patients admitted to a subacute rehabilitation facility will not achieve functional gains and return home. However, it is our moral duty to do right for the patient. The skills of rehabilitation of the hand become secondary to lifelong needs of this patient. Hand therapists can provide guidance and impart knowledge to subacute therapists who have never treated replantation injuries yet alone anything related to hand injuries such as fractures.