From the Research
The rehabilitation program for a patient with extensive leg muscle injury, fibular artery and nerve damage, and post-fasciotomy awaiting a graft should begin with a protective phase focusing on wound healing and pain management, utilizing analgesics such as acetaminophen and NSAIDs like ibuprofen, as supported by the most recent study on pain management 1.
Initial Phase
The initial phase of rehabilitation should prioritize wound healing and pain management.
- Analgesics such as acetaminophen 1000mg every 6 hours and/or NSAIDs like ibuprofen 400-600mg every 6-8 hours should be administered if not contraindicated, as these have been shown to be effective in managing pain without significant differences in efficacy between them and opioid combinations in acute extremity pain 1.
- Physical therapy should commence with gentle range of motion exercises, avoiding stress on the injured area, and progress to more active movements as healing permits.
Progressive Rehabilitation
Once the graft has been placed and adequately healed (typically 2-3 weeks post-surgery), a graduated strengthening program can begin.
- This should start with isometric exercises and advance to resistance training, aiming to restore muscle function and strength.
- Neuromuscular electrical stimulation may be beneficial for maintaining muscle mass and preventing atrophy, particularly important due to the fibular nerve damage which may cause foot drop requiring an ankle-foot orthosis.
- Gait training with appropriate assistive devices should be incorporated as weight-bearing status improves.
Monitoring and Individualization
Throughout rehabilitation, close monitoring for compartment syndrome recurrence, infection, and vascular compromise is essential.
- The program should be individualized based on surgical outcomes, with the ultimate goal of restoring function through progressive loading while respecting tissue healing timeframes.
- Rehabilitation may extend 6-12 months, with nerve regeneration potentially taking longer at a rate of approximately 1mm per day.
Key Considerations
- The choice of analgesic should consider the potential benefits and risks, including the gastrointestinal risks associated with NSAIDs 2 and the lack of significant difference in pain reduction between NSAIDs and opioid combinations in acute settings 1.
- The use of ibuprofen has been shown to decrease muscle soreness after eccentric exercise but does not assist in restoring muscle function 3.
- Novel drug products like OMS103HP, containing ketoprofen, amitriptyline, and oxymetazoline, have been investigated for improving joint motion and function and reducing pain after arthroscopic surgeries, showing promise in reducing postoperative pain and improving knee function 4.