Postoperative Nursing Care After Partial Finger Amputation: Protocol & Rehabilitation

Vitals q1h x4, q4h x24h: Temp, HR, BP, SpO₂, pain (FLACC/NRS).
Neurovascular Checks q1h x4, q4h x24h: Capillary refill <3s, color, warmth, sensation (2-point discrimination), motor (active flexion/extension), radial/ulnar pulse.
Elevation: Hand > heart level on pillows/hand board; foam elevation splint.
Ice: 20 min on/40 min off (barrier cloth); first 48h only.
Dressing: Non-adherent (Adaptic/Xeroform) + fluff + Kerlix + ace wrap (distal to proximal). Keep dry, intact.
Analgesia: Scheduled acetaminophen 1g q6h + celecoxib 200 mg q12h; opioid PRN breakthrough (oxycodone 5 mg q4h).
Antibiotics: 24h perioperative cefazolin 2g IV q8h (adjust for allergy).
Tetanus: Update per CDC guidelines.

Dressing Changes: Daily x3 days, then q2-3d. Assess: granulation, exudate, odor, maceration, epithelial advancement.
Infection Signs: Erythema >2cm, purulence, crepitus, fever >101°F, rising WBC/CRP.
Suture Removal: 10-14 days (finger); staples 12-14 days.
Scar Management (Post-epithelialization): Silicone gel/sheet 12h/day; scar massage 5 min BID; pressure garment if hypertrophic risk.

Phase	Timeline	OT/PT Focus
Protective	0-2 wks	Edema control (retrograde massage, Coban), AROM proximal joints, desensitization (textures), ADL training (one-handed)
Early Mobilization	2-6 wks	PROM → AAROM → AROM distal joints; tendon glides; intrinsic/extrinsic strengthening; scar mobilization
Functional Integration	6-12 wks	Task-specific training (keyboard, tools, instruments); work simulation; graded return
Advanced	12+ wks	Sport/hobby-specific; grip/pinch strength ≥90% contralateral; sensory re-education

Neuroma: Tinel's sign at stump; consider perineural catheter or revision.
Cold Intolerance: 50%+ incidence; thermal gloves, vasodilators (nifedipine).
Contracture: Night extension splinting; serial casting if PROM loss >20°.
CRPS (Type I): Budapest criteria; early PT + gabapentin + bisphosphonate + psych.