Building an Interdisciplinary Clinic for Upper Extremity Reconstruction in Spinal Cord Injury - The Montreal TetraHand Experience

Sep 30, 2026

Uploaded by Adam

Restoring upper extremity function is a top priority for tetraplegic patients, yet upper extremity (UE) reconstructive surgery in spinal cord injury (SCI) remains substantially underused due to implementation barriers and care complexity. The interdisciplinary Montreal TetraHand clinic was developed to provide a full spectrum of UE reconstruction and address known obstacles. The initial five-year period included 65 consultations and 23 UE surgeries, producing a 35.4% conversion rate and a 5.75-fold rise in annual case volume versus the prior model. The program emphasizes a dedicated interdisciplinary team, broad referral network, and targeted clinical strategy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

Barriers to Accessing UE Reconstructive Surgery

Special Topic Hand Building an Interdisciplinary Clinic for Upper Extremity Reconstruction in Spinal Cord Injury: The Montreal TetraHand Experience Noah Oiknine, MD, MSc(c)* Dominique Tremblay, OT, MD, FRCSC†‡ Géraldine Jacquemin, MD, MPH, FRCPC‡§ Catherine Dansereau, PT‡ Philippe Ménard, PT‡ Josée Dubois, OT‡ Marie-Ève Lamarche, OT‡ Marion Lack, OT‡ Elie Boghossian, MD, MSc, FRCSC†‡ Background: Restoring upper extremity (UE) function has consistently been ranked by tetraplegic patients as the most important function that would improve functional independence and quality of life. Given the reported underuse of UE reconstruction in spinal cord injury (SCI) and the complexity of these patients, an interdisciplinary clinic offering the full spectrum of UE reconstruction for this population was developed, taking into account known barriers. Methods: We describe the development and functioning of our interdisciplinary TetraHand clinic with consideration for recognized barriers to implementation. We herein share the lessons we have learned and describe our experience since the introduction of the clinic in 2019. Results: In the initial 5-year period since the establishment of the interdisciplinary Montreal TetraHand Clinic, 65 tetraplegic patients were seen in consultation, and 23 underwent UE reconstructive surgery (18 bilateral, 5 unilateral), yielding a 35.4% conversion rate. Compared with the previous model of care under which only 10 patients underwent unilateral UE reconstructive surgery over a 12-year period, the interdisciplinary clinic achieved a 5.75-fold increase in annual case volume. Conclusions: Building a successful TetraHand program requires the recruitment of a dedicated interdisciplinary team including hand surgeons, physiatrists, therapists, the establishment of a vast referral network, and a targeted clinical strategy to address barriers to providing care for the complex SCI population. This interdisciplinary clinical model has led to a significant increase in operative volumes and referrals, enabling us to provide comprehensive UE reconstructive surgery for SCI patients. (Plast Reconstr Surg Glob Open 2026;14:e7399; doi: 10.1097/GOX.0000000000007399; Published online 8 January 2026.) INTRODUCTION The estimated incidence of traumatic spinal cord injury (SCI) in the United States is 54 cases per million, From the *Division of Plastic andReconstructive Surgery, University of Montreal, Montreal, Quebec, Canada; †Division of Plastic and Reconstructive Surgery, University of Montreal, MaisonneuveRosemont Hospital, Montreal, Quebec, Canada; ‡Spinal Cord Injury Center of Expertise, Gingras-Lindsay Rehabilitation Institute of Montreal, Montreal, Quebec, Canada; and §Department of Physical Medicine and Rehabilitation, University of Montreal, Montreal, Quebec, Canada. Received for publication September 2, 2025; accepted November 14, 2025. Presented at the 2025 Canadian Society of Plastic Surgeons Annual Meeting, June 5, 2025, Toronto, Canada. Copyright © 2026 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. DOI: 10. 1097/GOX.0000000000007399 equaling roughly 18,000 new cases per year.1 On the other hand, the prevalence of individuals living with a traumatic SCI in the United States ranges from 257,000 to 388,000 .1 Patients experiencing an SCI resulting in tetraplegia are left with a myriad of physiological, psychological, and social challenges following injury.2,3 Among the functions lost post-SCI, regaining arm and hand function has consistently been ranked by tetraplegic patients as the top pri

FAQs

What problem does the Montreal TetraHand interdisciplinary clinic address?

It addresses the underuse of UE reconstructive surgery in SCI by creating an interdisciplinary clinic that offers the full spectrum of UE reconstruction for complex tetraplegic patients.

What outcomes were reported in the clinic’s initial five-year period?

Among 65 consulted tetraplegic patients, 23 underwent UE reconstructive surgery, yielding a 35.4% conversion rate.

How did the interdisciplinary clinic change patient volume compared with the previous model?

It achieved a 5.75-fold increase in annual case volume relative to the earlier 12-year period under which only 10 patients had unilateral UE reconstructive surgery.

Sep 30, 2026

Uploaded by Adam