Plastics

• Bachelor of Arts - Cum Laude - University of Chicago - 1998-2002
  
• Doctor of Medicine - Magna Cum Laude - Georgetown University School of Medicine - 2003-2007
  
• Intern - Plastic Surgery - Georgetown University (2007-2008)
  
• Resident - Plastic Surgery - Georgetown University (2008-2013)
  
• Fellow - Hand and Micro-vascular Surgery - University of Washington (2013-2014)
  

Dr. Iorio Publications

General Dressing: adaptic, 4×4, kerlix, 2 inch ace

REMOVE STAPLES FOR HEMATOMA AT BEDSIDE. Save the flap.

Close: Deep dermal, running subQ. Dressing: adaptic, 4×4, webroll, ace. Off on POD#5.

What are the areas of ulnar nerve compression? Remember wrist What vessel runs with ulnar nerve in elbow? ??Superior ulnar collateral

Know the cords. Reviewed z-plasty. Measure out. All lengths should be equal. Measure angle by other side of triangle

Remember that FPL tendon is coming around thenar muscles. Hold hand in almost an intrinsic plus position with finger tips pointed to ceiling. The A1 pulley is posterior to thenar area in this position. Incision should NOT be over thenar prominence. If so, you are too far radial/anterior. Know what muscles attach to A1 and oblique pulley. Know innervation of thenar musculature

2 ovals, cut out the middle and then sew together

Post-Surgery Time

Immediate Post Op Orders

Goals:

• OFF work x 2 days
• Elevate wrist above elbow x 2-3 days
• Finger and motion and typing as tolerated
• Remove dressing at POD 5

Work Restrictions

• 2-3 days post op: OFF work
• 0-2 weeks: 5-10 lb. lifting limit, no pushing or pulling
• 2-4 week: <20 lbs., then no restrictions

10-14 Days Post-surgery\\

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal
• Range of motion and edema control
• OT PRN

OT (if ordered beyond PE duties on 1st post op visit)

• 2-4 weeks post op

Finger and wrist ROM, scar massage

• 4+ weeks post op

Scar desensitization/massage
Putty use
Strengthening and ROM as tolerated

6-8 weeks\\

• Second follow up visit (schedule with MD/PA) ONLY IF NEEDED

Dr. Iorio – Carpal Tunnel Release

Any patient with more than 1 elective procedure (trigger and CTR, multiple triggers, etc.…) needs a first postop visit with hand therapy between 5-7 days.

Dr. Iorio - CMC Arthroplasty

Post-Surgery Time

Immediate Post Op Orders

Goals:

• Keep splint/dressing intact until follow up
• Elevate until follow-up
• Move fingers as splint allows
• OFF work x 3-5 days post op
• POST OP PROTOCOL ORDERS

Work Restrictions

• 0-3 days: OFF work
• 0-2 weeks: Limited use of operative hand to tolerance
• 4-8 weeks: 3-5pound limit, light use of thumb
• 8-12 weeks, no weight limit

10-14 Days Post-surgery

• 1st follow up visit (Schedule with Physician Extender)
• Wound Check
• Suture Removal PRN (often does dissolvable sutures)
• Forearm based thumb spica cast

4 weeks

• 2nd post op follow up visit (Schedule with Physician Extender)
• Remove cast
• Transition to forearm based thumb spica zipper
• Order therapy to begin at 6 weeks post op

OT (start at 6 weeks)

• Begin OT at 6 weeks
• Gentle circumduction, flexion, extension, abduction, opposition, retroposition of thumb as well as AROM of wrist
• Desensitization
• May remove splint for exercises and showering/light activity

OT Progression (10 weeks)

• Wean from splint – use only for heavy activity
• Start light strengthening with putty
• Ok to have splint off in home/controlled environment, splint on when out in community.
• If no problems, d/c from OT to HEP

Dr. Iorio - Cubital Tunnel Release

Post-Surgery Time

Immediate Post Op Orders

Goals:

• Remove dressing at POD 5
• May move fingers, wrist, and elbow as tolerated
• OFF work x 2-3 days post-op

Work Restrictions

• Limited use of operative extremity to tolerance
• 0-2/3 days: OFF work
• 0-3 weeks: May use arm as tolerated; 5lb weight restriction
• 3-4 weeks: 10-15lbs as tolerated
• >5 weeks: no restrictions

10-14 Days Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal
• Review HEP for strengthening
• OT Order (PRN)

OT (if ordered beyond PE duties on 1st post op visit)

• Scar massage, desensitization, strengthening

8 Weeks

• F/U PRN: If patient has concerns or ongoing symptoms, 2nd follow up visit scheduled with MD/PA

Dr. Iorio - DeQuervain’s Release

Post-Surgery Time

Immediate Post Op Orders

Goals:

• Remove dressing at POD 5
• Elevate wrist x 3 days
• May move fingers as splint allows
• OFF work x 2 days post op
• Follow up 10-14 days post op
• POST OP PROTOCOL ORDERS

Work Restrictions

• 2-3 days post op: OFF work
• 0-2 weeks: OK light use for typing and paperwork
• 0-2 weeks: 5 pound lifting limit, no pushing or pulling
• 2-4 wk.: no restriction

10-14 Days Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal
• OT Order (PRN)

OT (if ordered beyond PE duties on 1st post op visit)

• ROM, Scar massage, desensitization

6-8 weeks

• FU PRN: If patient has concerns or ongoing symptoms, 2nd follow up visit scheduled with MD/PA

Dr. Iorio - Distal Radius Fracture s/p ORIF

Post-Surgery Time

Immediate Post Op Orders

Goals:

• Keep splint/dressing intact until follow up
• Elevate wrist until follow up
• May move fingers as splint allows
• OFF work x 3-5 days post-op
• Follow-up 10-14 days post-op
• POST OP PROTOCOL ORDERS

Work Restrictions

• During casting period: No lifting, pushing or pulling more than 5 pounds in casted extremity.

10-14 Days Post-surgery

• 1st post-op visit
• X-rays (3 views of wrist)
• Wound Check
• Suture Removal
• Short arm cast

4 weeks

• Schedule 2nd post op visit with Physician Extender
• Transition to Delta splint at ~4 weeks
• Begin OT vs next visit TBD by MD
• Begin AROM of wrist once transitioned into splint (4 weeks)
• begin weaning splint while at home (i.e. May remove to for ADLS)

6-8 weeks

• 3rd follow up visit with physician/PA, transition to Delta
• Begin OT if not already.

12 weeks

• Final Physician visit

Dr. Iorio - Dorsal/Volar Wrist Ganglion Excision

Post-Surgery Time

Immediate Post Op Orders

Goals:

• Remove dressing at POD 5
• Elevate wrist x 5 days
• May move fingers as splint allows
• OFF work x 2-3 days post-op
• Follow-up 10-14 days post-op
• POST OP PROTOCOL ORDERS

Work Restrictions

• 0-3 days: OFF work
• 5 days-2 weeks: may use as tolerated; 5 lbs. weight restriction
• 3-6 weeks: full use

10-14 Days Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal
• Review HEP for ROM, scar management
• OT Order (PRN)

6-8 weeks

• F/U PRN: If patient has concerns or ongoing symptoms, 2nd follow up visit scheduled with MD/PA

Dr. Iorio - Metacarpal Fractures s/p ORIF

Post-Surgery Time

Immediate Post Op Orders

Goals:

• Keep splint/dressing intact until follow up
• Elevate wrist until follow-up
• May move fingers as splint allows
• OFF work x 3-5 days post-op
• Follow-up 10-14 days post-op
• POST OP PROTOCOL ORDERS

Work Restrictions

• During casting period: No lifting, pushing or pulling more than 5 pounds in casted extremity.
• For 2 wks. post cast removal: May lift, push, or pull up to 10 pounds with splint ON
• For 2-6 wks. post cast removal: May gradually increase weight-bearing as tolerated, with splint always on when lifting more than 10 pounds.
• May d/c splint at 6 wks. following cast removal

10-14 Days Post-surgery

• Schedule 1st post op visit with Physician Extender
• X-rays (3 view hand)
• Wound Check
• Suture Removal
• OT Order (PRN)
• Discussion with physician/PA to determine type of short arm cast or splint.

OT (if ordered beyond PE duties on 1st post op visit)

• If in splint – begin AROM, edema and scar management

4-6 weeks

• 2nd follow up visit scheduled with MD/PA

6 weeks

• begin OT for ROM

Dr. Iorio - Trigger Finger Release

Post-Surgery Time

Immediate Post Op Orders

Goals:

• OFF work x 2 days
• Remove dressing 5 days post op
• Apply Band-Aid
• Keep wound dry, no ointments
• Motion as tolerated to digits, wrist
• Follow up 10-14 days post op
• POST OP PROTOCOL ORDERS

Work Restrictions

• 2-3 days post op: OFF work
• 0-2 weeks: OK light use of hand for typing, paperwork, 5 pound lifting limit
• 3-4 weeks: No restrictions

10-14 Days Post-surgery

• Schedule 1st post op visit with Physician Extender
• Wound Check
• Suture Removal
• Review HEP for ROM and strengthening, scar management
• OT Order (PRN/if >1 TFR)

OT (if ordered beyond PE duties on 1st post op visit)

• ROM and strengthening
• Edema control
• Scar massage

6-8 weeks

• F/U PRN: If patient has concerns or ongoing symptoms, 2nd follow up visit scheduled with MD/PA