What is a Microsurgical patient - Free-flaps, Revasc, ReplantNursing management – 1:1 nursing, heating, caffeine free, mobility, VTE, hydration, pain management, IDC, Microvascular observations Circulation – inflow, outflow, tissue damageMonitoring - what, whenEscalation process Outflow - Leech (chemical/organic)Inflow – OTExample – Revasc.

POP Slabs Casts and splintsWhat: Casts circumferential – static, reinforce compliance often splints – allow ROMWhy: General principles of immobilisationWhen: pre surgery, post surgery, protect structures, resting Protective positioningPOSI – position of safe immobilisation – when usedDorsal blockingSandwich slabsBackslabs / POPVolar / DorsalThumb Spica – Management of issuesTrouble shooting

Topics covered includeWound assessment: knowing the cause, colour, stage, location, duration, what the dressing looked like that was just removed Know what structures are damaged/repaired – positioningSimple/low profile dressings to allow for exercises and fit within splintsConsiderations: Pre/post surgery Patient considerations· Duration· Location· In/out patient· Compliance· Pain· Age· Employment· Healing inhibitors Escalation processesSuturesInterrupted (simple & Mattress) / continuous – where, when and whyAbsorbable / non-absorbable Common types of suturesMonocrylVicryl rapideNylon/Prolene

Episode 2 – Neurovascular observations In the context of post-surgery What – assessing circulation and nerve functionWhy - assessing for ImpairmentsSensation - active block/local anaesthetic, nerve injury – identified and repaired, swelling/tight cast/bandagesCompartment syndrome, limb ischaemia, stroke /cardiac problemsVascular - Bleed with swelling, limb ischaemiaTendon injury – not movingObservations - specific indicators Treatment – lower limbPractical – cut down, inform team