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Reconstructive surgery after stroke is just a small part of the entire recovery process that's involved in achieving the best results and function. The patient wanted to go immediate stroke care in the hospital setting. They will then undergo therapy and care by rehabilitation specialists after this. They will then achieve their plateau or final spontaneous recovery within about a year, at which point we get involved to do the reconstructive procedures. But after that, they would then return to the care of the rehabilitation specialist who will be caring for them over a number of years.
Reconstructive surgery after stroke is just a small part of the entire recovery process that's involved in achieving the best results and function. The patient wanted to go immediate stroke care in the hospital setting. They will then undergo therapy and care by rehabilitation specialists after this. They will then achieve their plateau or final spontaneous recovery within about a year, at which point we get involved to do the reconstructive procedures. But after that, they would then return to the care of the rehabilitation specialist who will be caring for them over a number of years.
We usually have to take such procedures in conjunction with a physical medicine and rehabilitation doctor. Somebody who's undertaken the rehab of the patient may have undergone some trials of Botox, is determined that the patient would benefit from a more significant intervention. We will see the patient assess them. Sometimes EMG or nerve testing studies can be used to help us determine which muscles are the biggest problem and then we can do a very focused intervention. Typically the procedures lasts less than an hour. They are soft tissue incision followed by cutting of the nerve branches and the patient could go home on an outpatient basis. And the recovery of function is almost immediately realized this should be done in conjunction with physical therapy. The patient to after the relaxation of the muscles will need to be trained on how to use the arm and how to get the most function out of what has been performed. So if it's the upper extremity an occupational therapists will work with us on recovering that function. If it's a lower extremity, the physical therapist and a gait training program will be involved teaching the patient how to land the foot on the heel and had a swing through more appropriately to get a better date.
When a patient is referred for possible reconstructive surgery for their hemiplegic limb, they will come to see us in the clinic and often the surgeons or the surgeons with the therapists together will perform the physical examination. We will then determine which procedures would be the most effective in this case. Sometimes we can determine this based on the physical examination alone and sometimes we need to do additional procedures such as the injections of lidocaine, botox, or the EMG. If those procedures are required, there's often a second visit involved. We undertake these interventions or these studies, we then see the patient back afterwards to assess the effect of those interventions. If they accomplished what we hope they would accomplish, we will then plan for surgery. Surgery is typically an outpatient procedure, usually lasting less than three hours and the patient would go home the same day. Pain usually is not significant and incisions usually close with absorbable sutures and skin glue so the patient can shower the same day or without any adverse effect of the wound. The patient usually within the same week is referred to physical therapy and began training and learning how to use the limb in its new configuration. The patient usually is referred to physical therapy and they will begin that therapy within a week of surgery. Immediately, the use of the limb will have changed and they will begin to learn how to use the limb in a more functional way.
In any patient who has suffered a stroke or brain injury resulting Hemiplegia, there are a number of surgical procedures that are available today to augment that function. Patients should be involved in rehabilitation with typical physical and occupational therapy, but once they've achieved the best function they can from that program, they should then consult with a reconstructive surgeon who will help them achieve the next level of function. Typically, a patient can gain a significant degree of independence with reconstructive procedures after hemiplegia. Once a patient has been stabilized and achieve their best recovery independently, the goal of the reconstructive neurosurgeon is to bring them to the next level of independence and functionality that is beyond what they could have recovered independently. In most patients, we can achieve significant independence and patients are usually quite happy with what's accomplished with the reconstructive procedures following hemiplegia.
These procedures do not result in a complete cure that is the hemiplegic limb that has been repaired doesn't look identical to the way it looked before surgery or to the other limb, but it does usually become much more functional. Functional tasks such as grabbing an object, feeding yourself, using a catheter, manipulating an iPhone. These sorts of things can often be accomplished, but different strategies are often required to accomplish those tasks than were required by the patient prior to the stroke.
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