A patient with a recent dorsum hand skin graft 5–7 days ago is seen by an occupational therapist. What is MOST appropriate at this stage?

• A. Instruct client in AROM of the wrist and hand but limit PROM until staples are removed
• B. Fabricate and fit the client with a safe position splint over the dressings
• C. Involve the use of the grafted hand in ADLs that involve resistive grasp
• D. Perform PROM to the wrist and hand but instruct the client to limit use outside therapy sessions

Answer: (B)

The main concept here is protecting a fresh skin graft during the critical early healing period. In the first week after a hand graft, the graft is vulnerable to disruption from movement, shear forces, and pressure. Immobilizing the hand with a protective splint that places the joints in a safe position over the dressings helps preserve graft integrity, control swelling, and prevent contractures as the graft takes and adheres to the underlying tissue.

Starting active movement or resistive use too soon can disrupt graft take and lead to poor outcomes, which is why strategies that involve ROM, PROM, or resistive activities are not appropriate at this stage. A splint keeps the graft protected while allowing necessary healing, making it the best choice.