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Papers by Patrick Harris

Canadian Journal of Plastic Surgery, 2003

Complications following free tissue transfer have been well established in the literature. Common... more Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, ‘rare’ causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption.

Canadian Journal of Plastic Surgery, 2004

Orbital fractures are common fractures of the midface. As such, numerous techniques and materials... more Orbital fractures are common fractures of the midface. As such, numerous techniques and materials exist for the repair of this region, each with inherent advantages and disadvantages. But does the ideal implant material exist? Should we stop and simply use readily available materials, or should the cycle of need and discovery continue? a comprehensive review of materials used in orbital reconstruction and possible new directions in orbital floor reconstruction are presented.

Plastic surgery, 1995

Knowledge of the initial time required to repair the endothelial surface of small vessels after m... more Knowledge of the initial time required to repair the endothelial surface of small vessels after microsurgical vascular anastomosis of veins and arteries is required to determine the preferable duration of antiplatelet prophylaxis and anticoagulation after emergency or elective microsurgery. To determine this, the femoral arteries and veins of 16 Sprague-Dawley rats were isolated, sectioned and repaired with microsurgical technique. The animals were then killed at one day intervals from the first to the 16th postoperative day. Femoral veins and arteries were harvested, sectioned and prepared for scanning electron microscopy. The results show that endothelialization of the repair line is begun by day 3 and completed by day 7 in the veins and arteries. Endothelialization of the intraluminal protruding sutures takes nine days in the veins while it is only starting at day 15 in the arteries. If this model can be extended to the human clinical situation, antiplatelet prophylaxis or anticoagulation should be administered for at least seven days. Further study is required to evaluate the thrombogenic potential of intraluminal protruding sutures.

The Journal of Trauma: Injury, Infection, and Critical Care, 2005

Background-After conventional resuscitation from hemorrhagic shock, splanchnic microvessels progr... more Background-After conventional resuscitation from hemorrhagic shock, splanchnic microvessels progressively constrict, leading to impairment of blood flow. This occurs despite restoration and maintenance of central hemodynamics. The authors' recent studies have demonstrated that topical and continuous ex vivo exposure of the gut microvasculature to a glucose-based clinical peritoneal dialysis solution (Delflex), as a technique of direct peritoneal resuscitation (DPR), can prevent these postresuscitation events when initiated simultaneously with conventional resuscitation. This study aimed to determine whether DPR applied after conventional resuscitation reverses the established postresuscitation intestinal vasoconstriction and hypoperfusion. Methods-Male Sprague-Dawley rats were bled to 50% of baseline mean arterial pressure and resuscitated intravenously over 30 minutes with the shed blood returned plus two times the shed blood volume of saline. Initiation of ex vivo, topical DPR was delayed to 2 hours (group 1, n = 8), or to 4 hours (group 2, n = 8), respectively, after conventional resuscitation. Intravital microscopy and Doppler velocimetry were used to measure terminal ileal microvascular diameters of inflow A1 and premucosal A3 (proximal pA3, distal dA3) arterioles and blood flow in the A1 arteriole, respectively. Maximum arteriolar dilation capacity was obtained from the topical application, in the tissue bath, of the endothelium-independent nitric oxide-donor sodium nitroprusside (10 −4 M). Results-Hemorrhagic shock caused a selective vasoconstriction of A1 (− 24.1% ± 2.15%) arterioles from baseline, which was not seen in A3 vessels. This caused A1 blood flow to drop by −68.6% of the prehemorrhage value. Conventional resuscitation restored and maintained hemodynamics in all the animals without additional fluid therapy. In contrast, there was a generalized and progressive postresuscitation vasoconstriction of A1 (−21.7%), pA3 (−18.5%), and dA3 (−18.7%) vessels. The average postresuscitation A1 blood flow was −49.5% of the prehemorrhage value, indicating a persistent postresuscitation hypoperfusion. Direct peritoneal resuscitation reversed the postresuscitation vasoconstriction by 40.9% and enhanced A1 blood flow by 112.9% of the respective postresuscitation values. Conclusions-Delayed DPR reverses the gut postresuscitation vasoconstriction and hypoperfusion regardless of the initiation time. This occurs without adverse effects on hemodynamics. Direct peritoneal resuscitation-mediated enhancement of tissue perfusion results from the local effects from the vasoactive components of the Delflex solution, which are

Journal of the American Society of Nephrology, 2005

Conventional peritoneal dialysis solutions (PDS) are vasoactive. This study was conducted to iden... more Conventional peritoneal dialysis solutions (PDS) are vasoactive. This study was conducted to identify vasoactive components of PDS and to describe quantitatively such vasoactivity. Anesthetized nonheparinized rats were monitored continuously for hemodynamics while the microvasculature of the jejunum was studied with in vivo intravital microscopy. In separate experiments, vascular reactivity of rat endothelium-intact and-denuded aortic rings (2 mm) was studied ex vivo in a standard tissue bath. In both studies, suffusion of the vessels was performed with filter-sterilized isotonic and hypertonic solutions that contained glucose or mannitol as osmotic agents. PDS served as a control (Delflex 2.25%). Hypertonic glucose and mannitol solutions produced a significant vascular reactivity in aortic rings and instantaneous and sustained vascular relaxation at all levels of the intestinal microvasculature. Similarly, lactate that was dissolved in a low-pH isotonic physiologic salt solution produced significant force generation in aortic rings. Whereas isotonic glucose and mannitol solutions had no vasoactivity in aortic rings, isotonic glucose produced a selective, insidious, and time-dependent vasodilation in the intestinal premucosal arterioles (18 ؎ 0.2% of baseline), which was not observed in the larger inflow arterioles (100 m). This isotonic glucosemediated vascular relaxation can be attenuated by approximately 50% with combined adenosine A 2a and A 2b receptor antagonists and completely abolished by adenosine A 1 receptor inhibition. By using two different experimental techniques, this study demonstrates that hyperosmolality and lactate are the major vasoactive components of clinical peritoneal dialysis solutions. The pattern and the magnitude of such reactivity are dependent on vessel size and on the solutes' metabolic activity. Low pH of conventional PDS is not a vasoactive component by itself but renders lactate vasoactive. Energy-dependent transport of glucose into cells mediates vasodilation of small visceral arterioles by an adenosine receptor-mediated mechanism and constitutes a significant fraction of PDS-mediated vascular reactivity in the visceral microvasculature.

Microsurgery, 1994

Between 1985 and 1991, 13 muscular free flaps with split thickness skin grafts (10 latissimus dor... more Between 1985 and 1991, 13 muscular free flaps with split thickness skin grafts (10 latissimus dorsi, 2 rectus abdominis, and 1 gracilis) were done in 12 patients to cover the weight bearing surface of the foot. Four open wounds were closed primarily and nine unstable scars were replaced with a free flap.A retrospective analysis shows that over the short term the flaps provided a complete coverage of wounds, with a 100% survival of flaps, and permitted normal weight bearing ambulation starting at 1 month postoperatively. Long‐term results show deep pressure sensation but no light touch sensation. All patients are able to wear normal shoes. Six patients (seven flaps) required further surgery to close subsequent wounds on the flaps: Three hypertrophic scars with recurrent ulcerations needed scar revisions, one child presented a fistula through the flap due to underlying osteomyelitis, and one patient presented a friction wound on the lateral malleolus requiring thinning of the flap. Two flaps presented an area of pressure necrosis through the full thickness of the flap and had to be replaced with another free flap (fasciocutaneous sensate flap) over the heel area.In conclusion, it seems that in the pediatric population, skin‐grafted muscular coverage of the weight bearing surface of the foot is a good alternative, even if more problems with hypertrophic scarring around the grafts have been found than in the adult population. In two cases, the flaps had to be replaced because of pressure necrosis over the calcaneus. Long‐term follow‐up of the sensate fasciocutaneous flaps will be needed to find out if they provide a better alternative for foot coverage. © 1994 Wiley‐Liss, Inc.

Journal of Hand Therapy, Apr 1, 2018

Study Design: Literature review. Introduction: Pain is a subjective experience that results from ... more Study Design: Literature review. Introduction: Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. Purpose of the Study: This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. Methods and Results: This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. Discussion and Conclusion: Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.

Journal of Hand Therapy, Mar 1, 2023

Annals of the Rheumatic Diseases, Jun 1, 2020

Background: In chronic rheumatic diseases, non-adherence to treatment is associated with a progre... more Background: In chronic rheumatic diseases, non-adherence to treatment is associated with a progression of disease and an increased morbidity (1). In spondyloarthritis (SpA), improving patients' knowledge on their subcutaneous biologic disease-modifying antirheumatic drugs (bDMARDs) is a key factor to enhance medication adherence (2). The patient information has to ensure the acquisition of safety skills regarding their treatment management. Objectives: To evaluate the impact of a pharmacist's educational interview on knowledge and therapeutic adherence of subcutaneous bDMARDs in patients with SpA. Methods: Population and study design: consecutive adult patients with well-controlled axial SpA, stable on subcutaneous bDMARDs were enrolled in a randomized, controlled, single-center, open-label, 6-months trial. Intervention: A pharmacist's educational interview provided information on bDMARDs management at baseline in the intervention group (IG) and at month 6 (M6) in the control group (CG). A booklet containing essential information was given to the patient. Intervention allocation: After written consent, the study treatment was randomly allocated via a computer program by simple randomization, with an allocation ratio of 1:1. Outcome measures: The change of a weighted knowledge score (0-100) concerning the bDMARDs management and the change in the Medication Possession Ratio (MPR) at M6 were primary outcomes. The changes in disease activity (BASDAI) and patients' satisfaction regarding the pharmacists' interview were secondary outcomes. Statistics: Changes in knowledge score, MPR and BASDAI were compared between the two groups using the T-Student test. Statistical analysis was performed in intention-to-treat. Missing data was handled with multiple imputations. Results: Patients' characteristics at baseline were comparable among the 89 included patients (46 in IG, 43 in CG). The means ± SD of the knowledge score were 75.3 ±14.2 versus 73.0 ±13.2 and 86.3 ±12.6 versus 76.0 ±14.1 in the IG versus CG at baseline and at M6, respectively. The patient's knowledge score improved at a greater magnitude in the IG (+11.0 ±11.5 versus +3.0 ±10.6 in the IG versus the CG respectively, p<0.0001). The MPR at baseline were very high in both groups (92.9 ±14.6% versus 96.6 ± 15.6% in the IG versus the CG, respectively). There was a trend in a better adherence (+2.2 ±13.9 versus-0.6 ±18.9 in the IG versus the CG in the MPR score respectively, p = 0,691). The disease activity (changes in BASDAI) remained stable during the study in both groups. All the patients were mostly or totally satisfied by the pharmacists' interview. Conclusion: Pharmacists' educational interview on subcutaneous bDMARDs is effective in improving the knowledge of patients with SpA on their treatment. Regarding therapeutic adherence, a trend in favor of an improvement was observed in the intervention group but did not reach the statistically significance. Nevertheless, the results observed in this study are an argument to propose to include the pharmacists in the multidisciplinary team in charge of the management of patients with SpA. References: [1] Bluett J, Morgan C, Thurston L et al. Impact of inadequate adherence on response to subcutaneously administered anti-tumour necrosis factor drugs: results from the biologics in rheumatoid. Rheumatology. 2015;54(3):494-9. [2] Gossec L, Molto A, Romand X et al. Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus.

Plastic and Reconstructive Surgery, Jun 19, 2023

Journal of hand surgery global online, May 1, 2021

PurposeThis systematic review (SR) aimed to identify the surgical interventions available for tra... more PurposeThis systematic review (SR) aimed to identify the surgical interventions available for trapeziometacarpal osteoarthritis and document their efficacy on pain, physical function, psychological well-being, quality of life, treatment satisfaction, and/or adverse events.MethodsThis PROSPERO-registered SR’s protocol was developed based on the Cochrane intervention review methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsAmong 9049 potential studies identified, 1 SR, 18 randomized controlled trials, and 40 nonrandomized controlled trials were included. We identified 11 categories of surgical techniques: first metacarpal osteotomy, first metacarpal and trapezium partial resection, arthrodesis, trapeziectomy (T), T+ligament reconstruction (LR), T+tendon interposition (TI), T+ligament reconstruction and tendon interposition (LRTI), hematoma distraction arthroplasty (HDA), chondrocostal graft interposition, autologous fat injection, and manufactured implant use. These findings supported by low-quality evidence revealed moderately or largely superior effects of the following interventions: (1) trapeziectomy over T+LRTI using ½ flexor carpi radialis (FCR) and metacarpal tunnel (MT) or using abductor pollicis longus (APL) and FCR for adverse events; (2) trapeziectomy over T+TI using palmaris longus (PL) for pain; (3) T+LR with ½FCR-MT over T+LRTI with ½FCR-MT for physical function; (4) trapeziectomy by anterior approach over that by posterior approach for treatment satisfaction and adverse events; (5) T+LRTI using ½FCR-MT over T+TI with PL for pain; and (6) T+HDA over T+LR using APL-MT-FCR for pain, physical function, and adverse events. GraftJacket (Wright Medical Group, Memphis, TN), Swanson (Wright Medical Group, Letchworth Garden City, UK), and Permacol (Tissue Science Laboratories, Aldershot, UK) implants and hardware (plate/screw) would cause more complications than an autograft. The effect estimates of other surgical procedures were supported by evidence of very low quality.ConclusionsThis SR provided evidence of the efficacy of various surgical interventions for trapeziometacarpal osteoarthritis. Some interventions showed a moderate-to-large superior effect on the studied outcome(s) compared with others. However, these findings must be interpreted with caution because of low-quality evidence. To provide stronger evidence, more randomized controlled trials and methodological uniformization are needed.Type of study/level of evidenceTherapeutic I.

Arthritis Care and Research, Nov 7, 2020

Objective This systematic review (SR) aimed to synthesize the literature on the efficacy of exist... more Objective This systematic review (SR) aimed to synthesize the literature on the efficacy of existing non-surgical interventions for trapeziometacarpal osteoarthritis (TMO). Methods A medical librarian conducted an electronic search in 16 databases. Two authors independently carried out study selection, data extraction, and risk of bias assessment. The Agency for Healthcare Research and Quality guidance was followed to integrate a valid body of evidence Accepted Article This article is protected by copyright. All rights reserved from the existing SRs. Intervention effects were estimated based on the Cochrane Collaboration review methodology. Results We identified 17 SRs, 34 randomized controlled trials (RCTs), and 6 non-RCTs. Most of them had unclear or high risk of biases. Evidence of low to moderate quality supports the superiority of the following interventions for pain and/or physical function: 1) saline over steroid intra-articular injections confirmed by radiography; 2) saline injections over sham (i.e., pressure) in tender subcutaneous areas; 3) custom-made thermoplastic thumb orthosis over no intervention or a control; 4) custom-made thermoplastic hand-based trapeziometacarpal (TM) joint orthosis over no intervention; 5) radial nerve mobilization over sham ultrasound; 6) combination of hand exercises, TM-joint and median/radial nerve mobilization over sham ultrasound. Conclusion This comprehensive SR allowed collating evidence-based data on the efficacy of nonsurgical interventions for TMO. Steroid intra-articular injections would not be more effective than saline injections. Rehabilitative interventions (orthosis, exercises, nerve mobilization) would be efficacious. However, these findings must be treated with circumspection due to methodological limitations in many studies. Significance and Innovations  This systematic review is the first to include all non-surgical interventions (pharmacology, rehabilitation, alternative medicine) for trapeziometacarpal osteoarthritis (TMO). Our findings will be useful to clinicians for making scientific evidence-based decisions regarding the choice of the best therapeutic options.  Although steroid intra-articular injections are commonly used for osteoarthritis, this intervention would not be more effective than saline injections for TMO according to scientific evidence of moderate quality.  The efficacy for pain reduction and/or improvement of physical function of saline injections in tender subcutaneous areas, custom-made thermoplastic thumb, custom-made thermoplastic Accepted Article This article is protected by copyright. All rights reserved hand-based trapeziometacarpal (TM) joint orthosis, radial nerve mobilization and a combination of hand exercises, TM-joint/nerve mobilization is supported by scientific evidence of low quality which is still the best available evidence.

Plastic surgery, Sep 18, 2019

With surgical education moving from a time-based to a competency-based model, developing high-fid... more With surgical education moving from a time-based to a competency-based model, developing high-fidelity simulation models has become a priority. The Thiel cadaveric model has previously been used for a number of medical and surgical simulations, including microvascular simulation. We aim to investigate the use of the Thiel model in peripheral nerve simulation and validate a novel evaluation instrument. Sixteen residents ranging from postgraduate years 1 to 6 participated in the study. Their nerve coaptations using Thiel cadaveric nerves were video recorded and evaluated by 5 fellowship-trained microsurgeons using the Micro-Neurorrhaphy Evaluation Scale (MNES). The intraclass correlation among the 5 evaluators was 0.75, revealing excellent interrater reliability. The Cronbach α was .77, underlining the internal consistency of the test items. Bivariate analysis revealed a significant association between the MNES scores and the participants’ self-declared level of experience. This correlation was confirmed by mixed modeling. Our results validate the MNES and underscore the utility of the Thiel nerve tissue for peripheral nerve surgical simulation.

Microsurgery, Jun 24, 2017

Background: To prevent postoperative thrombosis, indications for anticoagulation in finger replan... more Background: To prevent postoperative thrombosis, indications for anticoagulation in finger replantation have been described, but no consensus has yet been found for cessation protocols. The aim of this study is to investigate cessation methods of intravenous anticoagulation after finger replantation. Methods: A retrospective review of all patients treated for a finger replantation between December 2014 and July 2016 was performed. Only those who required postoperative treatment with intravenous heparin were extracted. Primary outcome was survival of finger at hospital discharge and data collection focused on postoperative anticoagulation regimens. Results: 108 patients with replantation were treated with intravenous heparin and included in the analysis. When anticoagulated, survival rate was 60% (n 5 65) at hospital discharge, wherein arterial and venous thrombosis accounted for 60 and 40% respectively. Descriptive analysis failed to demonstrate an increase in failure rates when tested for duration of intravenous heparin, fixed or variable infusion rates of anticoagulation and need for vascular grafts. However, there was a 2.8fold (P 5 .009) increase in the survival rate with progressive weaning of anticoagulation rather than abrupt discontinuation. Subgroup analysis demonstrated similar findings when considering arterial thrombosis alone (OR 5.2, P 5 .012), but did not show any significant difference for venous thrombosis (OR 1.7, P 5 .344). Conclusions: Progressive tapering of intravenous heparin is associated with an increased survival rate after finger replantation, particularly for arterial thrombosis. Further prospective and randomized trials are necessary to elucidate the optimal duration, method of infusion and indications for vascular grafts.

Rehabilitation Research and Practice, Aug 26, 2018

The Left Right Judgement Task (LRJT) involves determining if an image of the body part is of the ... more The Left Right Judgement Task (LRJT) involves determining if an image of the body part is of the left or right side. The LRJT has been utilized as part of rehabilitation treatment programs for persons with pain associated with musculoskeletal injuries and conditions. Although studies often attribute changes and improvement in LRJT performance to an altered body schema, imaging studies suggest that the LRJT implicates other cortical regions. We hypothesized that cognitive factors would be related to LRJT performance of hands and feet and that sensory, motor, and pain related factors would be related to LRJT in the affected hand of participants with wrist/hand pain. In an observational cross-sectional study, sixty-one participants with wrist/hand pain participated in a study assessing motor imagery ability, cognitive (Stroop test), sensory (Two-Point Orientation Discrimination, pressure pain thresholds), motor (grip strength, Purdue Pegboard Test), and pain related measures (West Haven Yale Multidimensional Pain Inventory) as well as disability (Disability of the Arm, Shoulder and Hand). Multiple linear regression found Stroop test time and motor imagery ability to be related to LRJT performance. Tactile acuity, motor performance, participation in general activities, and the taking of pain medications were predictors of LRJT accuracy in the affected hand. Participants who took pain medications performed poorly in both LRJT accuracy (p=0.001) and reaction time of the affected hand (p=0.009). These participants had poorer cognitive (p=0.013) and motor function (p=0.002), and higher pain severity scores (p=0.010). The results suggest that the LRJT is a complex mental task that involves cognitive, sensory, motor, and behavioural processes. Differences between persons with and without pain and improvement in LRJT performance may be attributed to any of these factors and should be considered in rehabilitation research and practice utilizing this task.

Plastic and Reconstructive Surgery, Oct 1, 2015

Disclosure/Financial Support: No financial support received. None of the authors have a financial... more Disclosure/Financial Support: No financial support received. None of the authors have a financial interest to disclose related to this study. BACKGROUND AND PURPOSE: The injury mechanism is the most important factor determining survival rate and functional outcome in replantation surgery of the upper extremities. 1-2 However, injury causes are often underreported in the literature and overlooked in medical records. Thus, we sought to study the epidemiology of upper extremity injuries referred to our provincial replantation hand center.

Musculoskeletal science and practice, Dec 1, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Journal of Hand Therapy, Jul 1, 2016

Measures' (MOM) scale, a summarised performance indicator scale for the quality and performance o... more Measures' (MOM) scale, a summarised performance indicator scale for the quality and performance of a PRO that is reflective of the content of the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. Conclusion: The balance of psychometric properties and practical characteristics of the ULFI, ULFI-10 and ARGS demonstrated them as the optimum and preferred tools. The Quick-DASH-9 followed with less sensitivity on error range. All other PRO tools could not be advocated due to psychometric flaws that questioned their validity or use as a single summated score measurement tool. The DASH and UEFI demonstrated excessive internal consistency and consequently item redundancy. The Quick-DASH, UEFI, and UEFS demonstrated a dual factor structure and cannot be used for a single summated score. The PSFS and NRS were technically invalid as they respectively were not transferable between patients and did not present sufficient construct diversity. The ULFI and ULFI-10 and ARGS advantages are broader constructs from a higher item number with improved completion and scoring times; the Q-DASH-9 offers simplicity and speed but sacrifices construct diversity and sensitivity. Results: Each tool demonstrated the psychometric properties with criterion validity (range 0.70e0.98), test-retest reliability (ICC 2:1 > 0.92) and acceptable internal consistency (Cronbach's Alpha >0.80 and <0.95) except for the DASH (0.96) and UEFI (0.98) which showed item redundancy (Alpha > 0.95). The error scores ranged from MDC 90 ¼ 6%e13%, responsiveness ranged from ES¼ 0.9e1.2 and SRM ¼ 1.2e 2.

Journal of Hand Therapy, Oct 1, 2020

and motor impairment, and psychological (distress and anxiety) and social factors have previously... more and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. Purpose of the study: The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. Methods: Measures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with selfreported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Results: The best-fitting regression model with DASH scores entered as the dependent variable (F 4,50 ¼ 28.8, P < .01) included MPI Pain Interference (b ¼ À0.54), Life Control (b ¼ À0.16), Purdue pegboard scores (b ¼ À0.32), and Stroop test times (b ¼ 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R 2 ¼ 0.67, P < .01). Conclusion: Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.

Journal of Plastic Reconstructive and Aesthetic Surgery, May 1, 2016

Background: Venous congestion/insufficiency plays a major role in failure of finger replantation.... more Background: Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins. Methods: A retrospective review of finger amputations from 2011 to 2013 was conducted. The analyzed endpoint was the finger survival rate at discharge depending on the number of veins repaired: multiple veins (group 1), only one vein (group 2), or no veins (group 3). Proportions were compared using v2 tests/Fisher's exact tests; p-value <0.05 was considered significant. Results: Seventy-two patients with complete digital amputation were operated including 101 fingers. Twenty-seven fingers (26.7%) failed before hospital discharge, with 78% of failures due to venous complications versus 22% with an arterial etiology. Group 2 had 15 replantation failures due to venous causes as opposed to only one from group 1, representing a 1.27-fold (95% confidence interval (CI): 0.99, 1.34) increased relative risk of failure (p Z 0.032). Similarly, five fingers from group 3 suffered venous complications, resulting in a 1.49-fold (95% CI: 1.02, 1.73) increased likelihood of failure in comparison to group 1 (p Z 0.008). No significant difference was observed between having only one vein repaired versus none (RR: 1.1792, 95% CI: 0.83, 2.10, p Z 0.502). Conclusion: Efforts toward favoring two-vein repair lead to better survival of the replanted fingers. More cases need to be analyzed before formulating conclusions on specific levels of amputation with regard to venous anastomoses.