Plastics

General Information

• When consulting PT or OT, therapists must know the following information before an evaluation or treatment will be completed. If this information is absent, they will page you for clarification and will not see your patient until this information is obtained.
  
• For information regarding weight-bearing statuses and activity order options, refer to chart below.
  
• If there are no restrictions for a particular category, simply delete that item (you do not have to write “no restrictions”, therapists will assume that is the case if not mentioned).
  
• Once completed, copy and paste this information into a nursing communication “Activity Order” in Epic.
  
• If a splint is required for your patient, enter a separate nursing communication order to specify type of splint requested and additional details (see Splint information below).
  

• Included on this page are the restrictions of the most common plastic surgery operations, as well as an inclusive list of all information that may be required.
  

Weight-bearing statuses

• No restrictions: full weight-bearing
  
• WBAT: weight bearing as tolerated
  
• PFWB: platform weight bearing of UE
  
• TDWB: Touch down weight bearing-toe touch weight bearing (LE)
  
• PWB: Partial weight bearing (LE)
  
• NWB: Non-weight bearing
  

• Range of Motion: [enter extremity(ies), digits affected; degrees of motion allowed for each digit in each plane]
  
• Weight-bearing: [enter extremity(ies) affected, weight-bearing status of specified extremity(ies)]
  
• Elevation and Dangle: If continuous elevation required, state here. If dangle allowed (limb in gravity-dependent position), state [duration of time dangle allowed + number of times per day]
  
• Venous Flow Coupler and/or Vioptix: [enter amount of time coupler may be disconnected] [enter acceptable Vioptix parameters]
  
• Additional Restrictions: [enter lifting restrictions (in pounds), gross activity restrictions e.g. no pulling here]
  
• Post-operative activity pathway: [please use Activity Status chart to select level of activity in which pt may participate on which POD]. Example = POD 0: Bedrest; POD 1: Out of bed to chair; POD 2: Activity as tolerated
  
• Walker use allowed: Yes or No
  

• Range of Motion: No greater than 45 degrees in all planes of motion in bilateral shoulders
  
• Weight-bearing: BUE NWB
  
• Venous Flow Coupler: may be disconnected for no more than 10 minutes at a time.
  
• Walker use allowed: Yes, may rest hands gently on walker
  
• Additional Restrictions: No lifting greater than 5lbs, no pushing, no pulling
  
• Post-operative activity pathway = POD 0: Bedrest; POD 1: Out of bed to chair; POD 2: Activity as tolerated
  

• At post op visit <10 lb weight limit for 1 month. No pushing or pulling. Limit ROM of shoulders to 45 degrees in all directions.
  
• After 1 month: passive ROM of arms. Relax weight limits. by 6 weeks back to normal activity.
  

• Range of Motion: No shoulder ROM greater than 90 degrees in all planes
  
• Weight-bearing: BUE NWB
  
• Additional Restrictions: No lifting greater than 10lbs, no pulling, no pushing
  

• Weight-bearing: NWB to (specify extremity(ies) restricted)
  
• Additional restrictions: Use pillow under (specify RUE, LUE, BUE) while in bed to prevent pressure on flap. Use sling at all other times. Patient may have arm at side with sling in place for out of bed activities including ambulation.
  

• Weight-bearing: BLE WBAT
  
• Walker use allowed: Yes, if needed
  
• Additional Restrictions: Must ambulate with with legs shoulder-width apart (no thigh to thigh contact), abduction pillow while in bed, no active abduction of surgical (involved) extremity, keep surgical sites dry.
  
• Post-operative activity pathway = POD 0: Bedrest; POD 1: Activity as tolerated
  

Pain/perfusion catheter d/c POD#4 or #5 (5 days max per APS)

• Dangles (limb in gravity-dependent position): Begin on day 2, unless in frame - further information pending
  
• Additional Restrictions: pending
  
• Splint: Posterior splint required if no frame.
  
• Post-operative activity pathway: pending
  

• Weight-bearing: NWB to [involved extremity(ies)
  
• Elevation and Dangles (limb in gravity-dependent position): Keep (involved extremity(ies) elevated at all times POD 0-5. May begin dangles POD 6 for 5 minutes TID, increasing by 5 minutes per dangle daily as approved by plastic surgery team.
  
• Splint: If no frame present, posterior splint required.
  
• Post-operative activity pathway: POD 0-3: Bedrest, POD 4-5: out of bed to chair and commode with (involved extremity) elevated at all times, POD 6: Begin dangle protocol per above.
  

Splint ordering information pending

To be included
-Wear schedule
-Type
-WB Status
-ROM