Papers by Stephanie Thibaudeau
Background Exposure to plastic surgery during medical school is limited. Most interested applican... more Background Exposure to plastic surgery during medical school is limited. Most interested applicants form their perceptions of careers in this surgical specialty during elective rotations. Objective To investigate the perceptions of Canadian medical students considering a career in plastic surgery. The results obtained were then compared with current Canadian plastic surgery residents' perceptions. Methods The data were collected via two separate self-administered online surveys that were distributed to either Canadian plastic surgery residents or medical students. The questionnaires were similar and focused on three aspects: applicant details; driving force behind interest in the field; and essential character traits and competencies related to successful matching. Results Fifty-nine plastic surgery residents and 477 medical students participated in the online survey. The most commonly reported driving forces for interest in a plastic surgery career in both groups were variety o...
BACKGROUND Simulation has gained notable recognition for its role as an effective training and as... more BACKGROUND Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. METHODS A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrie...
Canadian Medical Education Journal
Background: Canadian medical school curriculums have undergone major restructuring during the COV... more Background: Canadian medical school curriculums have undergone major restructuring during the COVID-19 pandemic. This study’s goal was to assess the perceived impact of COVID-19 on medical students’ education and wellbeing. Methods: An online survey was distributed to Canadian medical students. Descriptive analyses and ANOVAs were used to assess changes in mental health, health habits and quality of education during the pandemic. Results: 248 medical students from 13 schools across Canada participated in this study. 74% reported a reduction in the quality of their education since COVID-19. 58% of students found online to be inferior to in-person teaching. 65% of students had more time for wellness and leisure activities, about half of the cohort felt more depressed (48%) and lonelier (52%). Student’s overall health habits worsened after the start of the pandemic (F=37.4, p < 0.001). Alcohol drinking, time spent seated, and screen time also increased since the pandemic (p < 0...
McGill Journal of Medicine
Purpose: No study in the literature compares different external distractors for PIPJ injury. We c... more Purpose: No study in the literature compares different external distractors for PIPJ injury. We compared a device described by Suzuki et al and another by Hynes & Giddins in non-injured cadaveric fingers. Main outcome measures were articular space and PIPJ flexion resistance.Methods: Thirty-two Thiel embalmed fingers were used. The elastics based model was performed with 3 and 5 elastics per side (3E and 5E); the 2-pin model used no elastics (2P). Articular distraction of each device was measured using x-ray imaging. The force required to flex the PIP joint to 45˚ and 90˚ in each group was measured with a dynamometer.Main findings: The articular distraction was statistically significant for all groups. The difference in articular distraction was significant in the AP view between groups 3E and 2P, and 5E and 2P. Flexion forces were only significant between group 5E and 2P at 90˚ flexion, but resistance was notably higher in group 2P than in groups 3E and 5E. Group 2P was more diffic...
Journal of Plastic, Reconstructive & Aesthetic Surgery
DeckerMed Plastic Surgery
The advent of free tissue transfer has revolutionized upper extremity reconstruction in the setti... more The advent of free tissue transfer has revolutionized upper extremity reconstruction in the setting of trauma, infection, and oncologic resection. Current microsurgical techniques allow for soft tissue coverage, osseous reconstruction, and free functioning muscle transfer. This review highlights perioperative planning considerations in terms of the timing of reconstruction and flap choice, as well as indications and contraindications, for upper extremity microsurgical reconstruction. Many commonly used fasciocutaneous, muscle, and osseous free flap options are reviewed, with specific emphasis on surgically relevant anatomy, flap variations, and pearls and pitfalls. Many of these free flap options are illustrated using case examples. This review contains 15 figures, 3 tables and 109 references. Key words: bone defect, elbow, free flap, hand, microsurgery, reconstruction, upper extremity, wrist
Plastic and Reconstructive Surgery
INTRODUCTION Non-surgical management of De Quervain's disease relies mainly on the use of ora... more INTRODUCTION Non-surgical management of De Quervain's disease relies mainly on the use of oral Non-Steroidal Anti-Inflammatory Drug administration, splint therapy, and corticosteroid injections. While the latter is most effective, with documented success rates of 61%-83%, there exists no clear consensus pertaining to conservative treatment protocols conferring the best outcomes. This article reports on all present conservative treatment modalities in use for the management of De Quervain's disease and highlights specific treatment- and patient-related factors associated with the best outcomes. METHODS A systematic search was performed using the PubMed database using appropriate search terms; two independent reviewers evaluated retrieved articles using strict inclusion and exclusion criteria. RESULTS A total of 66 articles met the inclusion criteria for review, comprising 22 articles reporting on outcomes following a single conservative treatment modality, 8 articles reporting on combined treatment approaches, 13 articles directly comparing different conservative treatment regimens, and 23 case reports. CONCLUSIONS A multimodal approach using splint therapy and corticosteroid injections appears to be more beneficial than either used in isolation. While there exists some evidence showing that multi-point injection techniques and multiple injections prior to surgical referral may provide benefit over a single point injection technique and a single injection prior to surgery, corticosteroid use is not benign and should thus be performed with caution. Ultrasound was proven valuable in the visualization of an intercompartmental septum, while ultrasound-guided injections were shown to be both more accurate and confer better outcomes. Several prior and concurrent medical conditions may affect conservative treatment outcome. A level I-II evidence-based treatment protocol is recommended for the optimal non-surgical management of De Quervain's disease.
Annals of Plastic Surgery
Background The medial femoral condyle (MFC) flap has become a popular choice for treatment of sma... more Background The medial femoral condyle (MFC) flap has become a popular choice for treatment of small bony defects. We aim to describe outcomes after MFC flap treatment of upper and lower extremity osseous defects and test the null hypothesis that no factors influence risks for nonunion, increased time to union, and complications. Methods A retrospective chart review was performed on all patients undergoing MFC free vascularized bone flaps by the senior author between May 2010 and March 2016. Preoperative, intraoperative, and postoperative data were collected. Results We identified 29 patients for inclusion (22 upper and 7 lower extremity reconstructions) treated with the MFC flap for diagnoses including long bone nonunion, avascular necrosis (AVN), or AVN with nonunion. Mean postoperative follow-up was 56 weeks. The average patient was 38 years old (range = 17–61 years) and had undergone 1.5 previous failed surgeries. Union was achieved in 86% of patients at a mean of 15.8 weeks (83% at 17.9 weeks for the scaphoid). No patient with lunate AVN progressed. There were no intraoperative flap complications or bone flap loss, but 28% underwent additional unplanned surgical procedures. We identified previous surgery as a risk factor for delayed union but did not observe significant risk factors predictive of nonunion or complications requiring unplanned reoperation. Conclusions Extremity reconstruction using the MFC corticocancellous flap results in a high rate of union yet minimal donor morbidity for a challenging patient cohort. Previous surgery was a risk factor for increased time to union.
Plastic and Reconstructive Surgery
BACKGROUND Simulation has gained notable recognition for its role as an effective training and as... more BACKGROUND Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. METHODS A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. RESULTS Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. CONCLUSIONS A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.
HAND
Background: Opioid abuse is a major health concern in North America. Data have shown an alarming ... more Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non–hand surgeon expertise (ie, intravenous sedation), as well as studies that include non–nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue.
The Journal of Hand Surgery
Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanc... more Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes.
Journal of the American Academy of Dermatology, Jan 5, 2017
Journal of Shoulder and Elbow Surgery
Elbow reconstruction with vascularized composite allotransplantation (VCA) may hold promise in tr... more Elbow reconstruction with vascularized composite allotransplantation (VCA) may hold promise in treating end-stage arthritis as no current treatment is both functional and durable. We describe the vascular and gross anatomy of the elbow in the context of VCA procurement and propose a step-by-step surgical technique for human elbow VCA. We injected latex in the arterial tree of 16 fresh adult cadaveric upper extremities. We identified and measured arteries and nerves and their branch points relative to the medial epicondyle. Based on our determination of the dominant blood supply to osseous and capsular elbow structures, we derived a cadaveric model of elbow VCA by performing donor preparation on 2 fresh cadaveric upper extremities by elevating a lateral arm flap in conjunction with the vascularized elbow joint. We prepared and transplanted 2 size-matched recipient specimens to refine the surgical technique. The elbow arterial supply was composed of consistent branches contributing to medial, lateral, and posterior arcades. Preservation of the elbow arterial network requires sectioning of the brachial, radial, and ulnar arteries 12 cm proximal, 1 cm distal, and 6 cm distal to the ulnar artery takeoff, respectively. The supinator, anconeus, distal brachialis, proximal aspects of the flexor digitorum profundus, and flexor carpi ulnaris must be preserved to protect osseous perforators. Articular innervation was most commonly derived from ulnar and median nerve branches. We refined our proposed surgical technique after performing 2 cadaveric elbow VCAs. Elbow VCA may be technically feasible on the basis of its consistent vascular anatomy and our proposed surgical technique.
Microsurgery
Free flaps derived from the medial genicular artery (MGA) system, including the medial femoral co... more Free flaps derived from the medial genicular artery (MGA) system, including the medial femoral condyle (MFC) and medial femoral trochlear (MFT) flaps, are potential reconstructive options to address upper and lower extremity bony pathology. Our primary aim was to comprehensively search the literature to describe the spectrum of pathology treated with these flaps, and to assess patient outcomes to improve our understanding of expected union and complication rates. Following PRISMA guidelines, a systematic review using Pubmed and Embase databases with citation cross-referencing was performed to identify all original clinical articles characterizing MGA flap treatment of upper and lower extremity pathology. The initial search identified 173 articles which was narrowed down to 40 meeting inclusion criteria, representing a total of 248 cases: 174 and 74 in the upper and lower extremities, respectively. Sixteen distinct recipient sites were identified with union rates ranging from 66 to 100% (98.7% overall). The majority (83.9%) of patients had undergone prior failed surgery. Major complications (those with limb/flap loss or requiring unplanned reoperation) were more frequent for lower versus upper extremity applications (17.1% vs. 6.2%, respectively). Donor site femoral fracture or persistent knee dysfunction occurred in 0.8% and 0.4% of patients, respectively. MGA free flaps are a versatile option for upper and lower extremity osseous reconstruction, offering high rates of union with minimal complications for a complex patient population. This study furthers our understanding of patient outcomes following MGA flap reconstruction, which previously was limited to case reports and small case series.
The Lancet Child & Adolescent Health
Although heterologous vascular composite allotransplantation has become a burgeoning treatment op... more Although heterologous vascular composite allotransplantation has become a burgeoning treatment option for adult amputees, there have been no successful cases previously reported in children. Here, we describe the surgical, immunological, and neurorehabilitation details with functional outcomes 18 months after heterologous bilateral hand and forearm transplantation in an 8-year-old child with quadrimembral amputations and a previous kidney transplant. 2 years of extensive preparation by medical and surgical teams preceded the hand-forearm transplantation of this child. The initial immunosuppressive protocol included thymoglobulin, tacrolimus, prednisone, and mycophenolate mofetil. In July, 2015, our vascularised composite allotransplantation team did the first bilateral hand and forearm transplantation in a child, an 8-year-old boy with previous living-related kidney transplantation. The surgery included four teams working simultaneously on the donor and recipient limbs, aided by customised cutting guides that aimed to reduce ischaemia time. Following an extended length of time in hospital, skin biopsies and close monitoring of renal function and drug concentrations occurred weekly for the first 3 months and were slowly tapered to monthly, and then quarterly. Skin biopsies were also done when tissue rejection was suspected. Paediatric-specific rehabilitation techniques were applied to promote patient engagement during rehabilitation. Progress was assessed by monthly sensory and motor function tests during routine clinic visits and with serial functional brain imaging studies, including structural brain MRI, magnetoencephalography and transcranial magnetic stimulation. The surgery lasted 10 h and 40 min. Vascular revision of the ulnar artery was required a few hours postoperatively. There were no further immediate postsurgical complications. Rejection episodes occurred throughout the first year but were reversed. An increase in serum creatinine led to the addition of sirolimus at 3 months after transplantation with concomitant reduction in tacrolimus targets. Sensibility to light touch was present by 6 months after transplantation. Intrinsic hand muscle innervation was present by 7-10 months after transplantation. At 18 months, the child had exceeded his previous adapted abilities. As of 18 months after transplantation surgery he is able to write and feed, toilet, and dress himself more independently and efficiently than he could do before transplantation. He remains on four immunosuppressive medications and functional neuroimaging studies have shown motor and somatosensory cortical reorganisation. Hand transplantation in a child can be surgically, medically, and functionally successful under carefully considered circumstances. Long-term data on the functional trajectory, neurological recovery, psychological sequelae, and the potential late effect of immunosuppression are still needed to support broader implementation of paediatric vascular composite allotransplantation. The Children&amp;amp;amp;amp;#39;s Hospital of Philadelphia.
The Journal of hand surgery, 2017
To characterize the clinical presentation, common pathogens, antimicrobial susceptibility, and tr... more To characterize the clinical presentation, common pathogens, antimicrobial susceptibility, and treatment methods associated with pyogenic flexor tenosynovitis (PFT) in pediatric patients. Patients who underwent surgical treatment for PFT at a large tertiary-care children's hospital between 2001 and 2015 were identified. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications. Thirty-two patients (71.9% male) with a mean age of 9.5 ± 5.5 years (range, 0.8-19 years) were included. At least 3 Kanavel signs were present on presentation in 62% of the cohort, with all 4 signs identified in 34%. Three children (9%) presented with 0 to 1 Kanavel signs, with semiflexed posturing of the digit as the least commonly (41%) manifested sign. The most frequently cultured organisms were methicillin-resistant Staphylococcus aureus (MRSA) (38%), methicillin-sensitive ...
The Journal of hand surgery, 2016
This article demonstrates a technique for the treatment of scaphoid fracture waist and proximal p... more This article demonstrates a technique for the treatment of scaphoid fracture waist and proximal pole nonunions with avascular necrosis using a free vascularized medial femoral condyle flap. We present our surgical technique and representative case examples in which the scapholunate ligament, a key structure required to preserve carpal kinematics, is spared.
Journal of Pediatric Surgery, 2016
To determine the incidence and risk factors of complications, reoperations and 30-day unplanned r... more To determine the incidence and risk factors of complications, reoperations and 30-day unplanned readmission after pediatric upper extremity surgery. Retrospective analysis of the 2013 National Surgery Quality Improvement Program pediatric database to identify procedures that met the CPT code of a primary upper extremity procedure. A univariate and multivariate analysis was performed to identify patient- and surgery-related risk factors for complications, reoperations and 30-day unplanned readmissions. Upper extremity pediatric surgeries have low complication (1.70%), reoperation (0.5%) and readmission rates (0.78%). Procedures requiring reoperation, inpatient procedures, and those complicated by surgical site infection were more likely to be readmitted. Patients with complex medical histories such as cardiac disease, gastrointestinal disease, pulmonary disease, or a central nervous system disorder were more likely to be readmitted. Pediatric upper extremity surgery is safe and associated with low complication and readmission rates. Algorithms focusing on decreasing surgical site infection and optimizing complex pediatric medical problems may limit or further decrease complication and readmission rates. Prognostic III.
Plastic and reconstructive surgery, 2016
Chronic ischemia of the hand can lead to intractable pain, cold intolerance, and digital necrosis... more Chronic ischemia of the hand can lead to intractable pain, cold intolerance, and digital necrosis, affecting up to 4.8 percent of patients undergoing vascular surgery. Treatment of patients suffering from chronic hand ischemia, in particular, the subset of patients with a nonreconstructible distal arterial tree, can be a significant challenge for hand surgeons. The purpose of this systematic review is to analyze the outcomes of surgical therapies in an effort to define the efficacy of each intervention. The authors also revisit the treatment algorithm for nontraumatic chronic hand ischemia. A systematic search of the literature published since 1990 in the PubMed/MEDLINE database was performed using keywords. Articles were eligible if they described clinical studies of human patients with nontraumatic chronic hand ischemia who underwent sympathectomy, arterial bypass, or venous arterialization. Pain improvement, wound healing, and new ulcerations were primary outcome measures. Primar...
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Papers by Stephanie Thibaudeau