POSTOPERATIVE PERIOD
After applying the dressing, the limb is fixed with a splint in the position, in which the limb was at the time of suturing, and the injured nerve is under the weakest traction. The immobilisation continues for three weeks. Any earlier mobilisation may be followed by tearing of the suture, while immobilisation for too long is also undesirable, as it may favour the development of scar tissue and stiff joints. Physical treatment must begin for all parts of the limb, which did not need to be immobilised. In peripheral nerve operations the early patient getting out of bed, usually on the next day of surgery is recommended.
Very often in the postoperative period, pain appears in the operative wound or in the territory of the affected nerves. They are due to the irritation of both vessels and nerve trunks. The characteristics and the intensity of the pain depend on the structure of the nerves operated on. Thus, with nerves with a larger quantity of sensory and sympathetic fibres the pain is more frequent and more intense (for instance with operations on the sciatic and unar nerve). Pain in the postoperative period is more frequently associated with combined operations on vessels and nerves or nerves and bones. Routine analgesics and sedative drugs usually control this type of pain. It is necessary to avoid giving narcotic drugs. If the pain is not due to a septic complication, they usually subside within some days after the operation.
In the postoperative check-up of the operative wound great attention should be paid to the development of haematomas in the operative wound, which are manifested by tension and bluish coloration of the skin. These haematomas must always be evacuated because they lead to the formation of adhesions around the operated nerve. When there are indications of haematoma accumulation, several stitches are removed and the blood is evacuated. If the removal of the haematoma is not possible in this way, the wound must be opened widely, the haematoma cleaned, haemostasis made, and the wound sutured anew.
The penetration of the infection deep into the wound and consequent tissues septic affection in the postoperative period frequently leads to the development of neuritis and to the formation of serious scar changes between the muscle and the nerves. If there is a septic complication, particularly with pus accumulation, part of the stitches must be removed and the wound drained, as well as applying active treatment with antibiotics.
Physiotherapy should begin, if possible, early in the postoperative period. Of course, this kind of treatment is a prolongation of the overall general treatment, which has begun before the operation. In the great majority of cases physiotherapy in the postoperative period helps to obtain a softening of the cicatrices, protect the muscles from atrophy and the joints from ankylosis. In case of neurolysis and when a nerve suture has been made without tension, these treatments should also begin earlier.