Bio

Clinical Focus


  • Peripheral Nerves
  • Tendon Injuries
  • Brachial Plexus
  • Hand
  • Plastic and Reconstructive Surgery
  • Neuroma
  • Entrapment Neuropathies
  • Plastic Surgery

Academic Appointments


Administrative Appointments


  • Medical Student Clerkship Director, Stanford Plastic Surgery (2008 - Present)

Honors & Awards


  • Career Development Award, VA (11/08)

Professional Education


  • Fellowship:Stanford University School of Medicine (2007) CA
  • Board Certification: Plastic Surgery, American Board of Plastic Surgery (2008)
  • Residency:University of Michigan Hospital (2006) MI
  • RWJ Clinical Scholar, Robert Wood Johnson Foundation, Heath Services Research (2004)
  • Internship:University of Michigan Hospital (1999) MI
  • Medical Education:Yale University School of Medicine (1998) CT
  • BA, Wellsely College, Russian studies (1993)
  • MD, Yale University (1998)

Research & Scholarship

Current Research and Scholarly Interests


Maintaining and optimizing upper limb function in people with spinal cord injury.
Improving pain and general well being after severe hand injuries.
Neuroma care in the surgical patient.

Clinical Trials


  • Minocycline to Reduce Pain After Carpal Tunnel Release Recruiting

    The investigators are looking at whether peri-operative minocycline will reduce the duration of pain after minor hand surgery: carpal tunnel release and trigger finger release. The investigators' hypothesis is that minocycline will reduce post-operative pain.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Needle Aponeurotomy for the Treatment of Dupuytren's Disease. Hand clinics Diaz, R., Curtin, C. 2014; 30 (1): 33-38

    Abstract

    Surgical treatment of Dupuytren's disease includes radical fasciectomy, limited fasciectomy, percutaneous needle aponeurotomy (PNA), and treatment with collagenase injections. The most commonly performed procedure is limited fasciectomy. However, techniques such as PNA and collagenase injections are being performed with higher frequency because they are minimally invasive. PNA is generally recommended for older patients with less severe contractures who desire a faster recovery with a low complication rate. Patients undergoing PNA should be informed that recurrence rates appear to be higher with PNA in comparison with limited fasciectomy.

    View details for DOI 10.1016/j.hcl.2013.09.005

    View details for PubMedID 24286740

  • Soft-Tissue Coverage of the Hand: A Case-Based Approach PLASTIC AND RECONSTRUCTIVE SURGERY Eberlin, K. R., Chang, J., Curtin, C. M., Sammer, D. M., Saint-Cyr, M., Taghinia, A. H. 2014; 133 (1): 91-101

    Abstract

    Adequate soft-tissue coverage of the hand is paramount to achieve optimal aesthetic and functional results in patients with complex hand defects. In this article, the authors present four illustrative clinical cases and discuss potential reconstructive modalities. For each scenario, two surgical options are discussed: one established and one nontraditional method of reconstruction. The authors' preferred method and technical pearls for execution are presented.

    View details for DOI 10.1097/01.prs.0000436831.73323.88

    View details for Web of Science ID 000329164900044

    View details for PubMedID 24105089

  • Surgical versus nonsurgical treatment of femur fractures in people with spinal cord injury: an administrative analysis of risks. Archives of physical medicine and rehabilitation Bishop, J. A., Suarez, P., DiPonio, L., Ota, D., Curtin, C. M. 2013; 94 (12): 2357-2364

    Abstract

    To assess the risks associated with surgical and nonsurgical care of femur fractures in people with spinal cord injury (SCI).Retrospective cohort study; an analysis of Veterans Affairs (VA) data from the National Patient Care Database.Administrative data from database.The cohort was identified by searching the administrative data from fiscal years 2001 to 2006 for veterans with a femur fracture diagnosis using the International Classification of Diseases, 9th Revision, Clinical Modification codes. This group was subdivided into those with (n=396) and without (n=13,350) SCI and those treated with and without surgical intervention.Not applicable.Rates of mortality and adverse events.The SCI group was younger with more distal fractures than the non-SCI group. In the non-SCI population, 78% of patients had associated surgical codes compared with 37% in the SCI population. There was higher mortality in the non-SCI group treated nonoperatively. In the SCI population, there was no difference in mortality between patients treated nonoperatively and operatively. Overall adverse events were similar between groups except for pressure sores in the SCI population, of which the nonoperative group had 20% and the operative had 7%. Rates of surgical interventions for those with SCI varied greatly among VA institutions.We found lower rates of surgical intervention in the SCI population. Those with SCI who had surgery did not have increased mortality or adverse events. Surgical treatment minimizes the risks of immobilization and should be considered in appropriate SCI patients.

    View details for DOI 10.1016/j.apmr.2013.07.024

    View details for PubMedID 23948614

  • A National Study on Craniosynostosis Surgical Repair CLEFT PALATE-CRANIOFACIAL JOURNAL Christine Nguyen, C., Hernandez-Boussard, T., Khosla, R. K., Curtin, C. M. 2013; 50 (5): 555-560

    View details for DOI 10.1597/11-324

    View details for Web of Science ID 000327536100011

  • Breast reconstruction national trends and healthcare implications. breast journal Hernandez-Boussard, T., Zeidler, K., Barzin, A., Lee, G., Curtin, C. 2013; 19 (5): 463-469

    Abstract

    Breast reconstruction improves quality-of-life of breast cancer patients. Different reconstructive options exist, yet commentary in the plastic surgery literature suggests that financial constraints are limiting access to autologous reconstruction (AR). This study follows national trends in breast reconstruction and identifies factors associated with reconstructive choices. Data were obtained from the Nationwide Inpatient Sample from 1998 to 2008. Patients were categorized as having either implant or ARs. Bivariate and multivariate regression analysis identified variables associated with receiving implants versus AR. Physician fee schedules were analyzed using national average Medicare physician reimbursement rates. From 1998 to 2008, 324,134 breast reconstructions were performed. Reconstructions increased 4% per year. The proportion of implant reconstructions increased 11% per year, whereasARs decreased 5% per year (p < 0.05). Our model showed that the odds of having implant-based versus AR were significantly associated with age, disease severity, payer type, hospital teaching status, and year of surgery. Year of surgery was the strongest predictor of implant reconstruction; patients receiving breast reconstructive surgery in 2009 were three times more likely to have implant breast reconstructive surgery compared with similar patients in 2002. Medicare reimbursement steadily declined for AR over a similar time frame. From 1998 to 2008, autologous breast reconstruction has significantly declined, parallel to a decrease in physician reimbursement. Our data found no significant change in patient characteristics supporting the lack of choice of AR. Further research is warranted to better understand this shift to implant reconstruction and to ensure future access of these complex reconstructive procedures.

    View details for DOI 10.1111/tbj.12148

    View details for PubMedID 23758582

  • Management of Chronic Pain Following Nerve lnjuries/CRPS Type II HAND CLINICS Carroll, I., Curtin, C. M. 2013; 29 (3): 401-?

    Abstract

    Chronic pain affects quality of life and adversely affects functional outcomes. Chronic postoperative pain is a frustrating problem for the surgeon because it ruins a technically perfect procedure, and the surgeon may be unsure of treatment strategies. There is much information on chronic pain and its treatment, but it is often published outside of surgery and diffusion of this information across disciplines is slow. This article synthesizes some of this literature and provides a systematic presentation of the evidence on pain associated with peripheral nerve injury. It highlights the use of perioperative and early intervention to decrease this debilitating problem.

    View details for DOI 10.1016/j.hcl.2013.04.009

    View details for Web of Science ID 000323627800009

    View details for PubMedID 23895720

  • Perioperative Interventions to Reduce Chronic Postsurgical Pain JOURNAL OF RECONSTRUCTIVE MICROSURGERY Carroll, I., Hah, J., Mackey, S., Ottestad, E., Kong, J. T., Lahidji, S., Tawfik, V., Younger, J., Curtin, C. 2013; 29 (4): 213-222

    Abstract

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors-so called "preventative analgesia." In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.

    View details for DOI 10.1055/s-0032-1329921

    View details for Web of Science ID 000317597000001

    View details for PubMedID 23463498

  • Changes resembling complex regional pain syndrome following surgery and immobilization. journal of pain Pepper, A., Li, W., Kingery, W. S., Angst, M. S., Curtin, C. M., Clark, J. D. 2013; 14 (5): 516-524

    Abstract

    The study of complex regional pain syndrome (CRPS) in humans is complicated by inhomogeneities in available study cohorts. We hoped to characterize early CRPS-like features in patients undergoing hand surgery. Forty-three patients were recruited from a hand surgery clinic that had elective surgeries followed by cast immobilization. On the day of cast removal, patients were assessed for vasomotor, sudomotor, and trophic changes, and edema and pain sensitization using quantitative sensory testing. Pain intensity was assessed at the time of cast removal and after 1 additional month, as was the nature of the pain using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). Skin biopsies were harvested for the analysis of expression of inflammatory mediators. We identified vascular and trophic changes in the surgical hands of most patients. Increased sensitivity to punctate, pressure, and cold stimuli were observed commonly as well. Moreover, levels of IL-6, TNF-alpha, and the mast cell marker tryptase were elevated in the skin of hands ipsilateral to surgery. Moderate-to-severe pain persisted in the surgical hands for up to 1 month after cast removal. Exploratory analyses suggested interrelationships between the physical, quantitative sensory testing, and gene expression changes and pain-related outcomes.This study has identified CPRS-like features in the limbs of patients undergoing surgery followed by immobilization. Further studies using this population may be useful in refining our understanding of CRPS mechanisms and treatments for this condition.

    View details for DOI 10.1016/j.jpain.2013.01.004

    View details for PubMedID 23453564

  • Analysis of Efficacy and Safety of Treatment With Collagenase Clostridium histolyticum Among Subgroups of Patients With Dupuytren Contracture. Annals of plastic surgery Raven, R. B., Kushner, H., Nguyen, D., Naam, N., Curtin, C. 2013

    Abstract

    Collagenase Clostridium histolyticum (CCH) injection is a nonoperative treatment of hand contractures from Dupuytren disease. This study assessed the efficacy and safety of CCH in several subgroups of patients with increased surgical risk.Data were pooled from 3 randomized, placebo-controlled, double-blind trials. This analysis included 271 patients with metacarpophalangeal (n = 167) or proximal interphalangeal (n = 104) joint contractures greater than or equal to 20 degrees treated with CCH (0.58 mg collagenase per injection). Subgroups included age, sex, and diabetes status. End points included rate of clinical success (reduction in contracture to 0-5 degrees of normal) and percentage of adverse events.There was no significant difference in clinical success by age, diabetes status, or sex with 63% reaching the end point. There was no difference in adverse events among the subgroups, with peripheral edema, contusion, and injection-site hemorrhage being most common.High-risk subgroups do not demonstrate differences in efficacy or safety with CCH treatment of Dupuytren-related contractures.

    View details for PubMedID 23511746

  • Ultrasound-guided Continuous Median Nerve Block to Facilitate Intensive Hand Rehabilitation CLINICAL JOURNAL OF PAIN Maxwell, B. G., Hansen, J. A., Talley, J., Curtin, C. M., Mariano, E. R. 2013; 29 (1): 86-88

    Abstract

    Continuous brachial plexus blocks for postoperative analgesia after upper extremity surgery are well described, but they can result in undesirable motor block and lack of specificity for minor hand procedures. We present the use of extended-duration continuous local anesthetic infusion through an ultrasound-guided median nerve catheter inserted at the forearm to facilitate hand physical therapy in a patient who had previously failed rehabilitation due to pain unrelieved by systemic opioids.A 54-year-old man presented with an inability to flex his index finger after proximal phalangeal fracture. He underwent hardware removal and extensive scar release. He had severe postoperative pain that limited his ability to comply with hand therapy, which is required to achieve functional goals after surgery. A perineural catheter was placed under ultrasound guidance adjacent to the median nerve in the proximal forearm; then a continuous infusion of ropivacaine 0.2% was initiated and maintained for 11 days. The patient had focused sensory loss in the median nerve distribution but maintained active flexion of the fingers. He subsequently was able to participate in hand physical therapy and discontinued the use of oral opioid medications.Ultrasound-guided perineural catheters targeting terminal branch nerves may have potential benefits beyond the immediate postoperative period and in nonoperative management of patients requiring physical therapy and rehabilitation.

    View details for DOI 10.1097/AJP.0b013e318246d1ca

    View details for Web of Science ID 000311945500014

    View details for PubMedID 22751029

  • Advances in the Management of Dupuytren Disease Collagenase HAND CLINICS Hentz, V. R., Watt, A. J., Desai, S. S., Curtin, C. 2012; 28 (4): 551-?

    Abstract

    Dupuytren disease (DD) is a benign, generally painless connective tissue disorder affecting the palmar fascia that leads to progressive hand contractures. Mediated by myofibroblasts, the disease most commonly begins as a nodule in the palm or finger, and can progress where pathologic cords form leading to progressive flexion deformity of the involved fingers. The palmar skin overlying the cords may become excessively calloused and contracted and involved joints may develop periarticular fibrosis. Although there is no cure, the sequellae of this affliction can be corrected. This article focuses on the role of collagen in DD and the development of a collagen-specific enzymatic treatment for DD contractures.

    View details for DOI 10.1016/j.hcl.2012.08.003

    View details for Web of Science ID 000311875800011

    View details for PubMedID 23101605

  • Who are the women and men in Veterans Health Administration's current spinal cord injury population? Journal of rehabilitation research and development Curtin, C. M., Suarez, P. A., Di Ponio, L. A., Frayne, S. M. 2012; 49 (3): 351-360

    Abstract

    Spinal cord injury (SCI) care is a high priority for the Veterans Health Administration (VHA). Aging Veterans, new cases of SCI from recent conflicts, and increasing numbers of women Veterans have likely changed the profile of the VHA SCI population. This study characterizes the current Veteran population with SCI with emphasis on healthcare utilization and women Veterans. We analyzed VHA administrative data from 2002-2003 and 2007-2008, analyzing composition, demographics, and healthcare use. The population is mostly male (>97%) and largely between 45 and 64 years old. Over 30% are over the age of 65. They are frequent users of healthcare, with an average of 21 visits per year. Women Veterans with SCI form a small but distinct subpopulation, being younger and less likely to be married and having a higher burden of disease. We must understand how the VHA population with SCI is changing to anticipate and provide the best care for these complex patients.

    View details for PubMedID 22773195

  • A National Study on Craniosynostosis Surgical Repair. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association Nguyen, C., Hernandez-Boussard, T., Khosla, R. K., Curtin, C. M. 2012

    Abstract

    Objective :? Our study aimed to use national data to assess the perioperative outcomes of craniosynostosis surgical repair. Design :? Data were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids Inpatient Database from 1997, 2000, 2003, and 2006. Setting :? Community hospitals in the United States. Patients :? The cohort was identified using the ICD-9-CM procedure codes for craniosynostosis surgical repair (2.01, 2.03, 2.04, 2.06). Main Outcome Measures(s) :? We determined patient and hospital characteristics. We clustered patients by age group (<7 months, 7 to 12 months, 1 to 3 years) and assessed mortality, comorbidities, mean length of stay (LOS), and total charge. We performed logistic regression with our dependent variable being longer average hospital stay: LOS >4.2 days. Results :? We found 3426 patients. Average age at the time of surgery was 181 days (SD 84). Average length of stay was 4.2 days. The majority of the patients were boys (66%), white (71%), and insured (93%). Nearly all patients underwent surgery in a teaching hospital (98%) in urban centers (99%). Approximately 10% of patients experienced an acute complication, most commonly hemorrhages or hematomas and airway or respiratory failure. Patients ages 1 to 3 years had the highest rates of comorbidities and a longer LOS. Mortality rate was <1%. Conclusions :? Craniosynostosis surgery is safe with low rates of mortality and acute complications. LOS >4.2 appears to be associated more with comorbidities than with complications. Higher rates of comorbidities and LOS >4.2 days for patients age 1 to 3 years warrant addition research to assess potential barriers to care.

    View details for PubMedID 23030675

  • Is carpal tunnel release under-utilized in veterans with spinal cord injury? JOURNAL OF SPINAL CORD MEDICINE Barr, C., Suarez, P., Ota, D., Curtin, C. M. 2011; 34 (6): 563-568

    Abstract

    Carpal tunnel syndrome (CTS) is a common disorder among individuals with spinal cord injury (SCI). Although carpal tunnel release is highly effective, the procedure may be under-utilized in this population. This study attempts to identify if CTS is under-treated in Veterans with SCI.The Veterans Affairs (VA) National Patient Care Database was used for data compilation within fiscal years 2007 and 2008. Using ICD-9-CM diagnoses codes, individuals with SCIs were identified, including those diagnosed with CTS. Current procedural terminology (CPT) codes further showed those who had undergone surgical intervention including open and endoscopic release of the transverse carpal ligament. The VA SCI cohort was compared to the general VA population with regard to demographics, diagnosis, surgical intervention, and treatment location.A total of 19 296 veterans with SCI were identified within the 2-year period. The prevalence of CTS within this cohort was 3.5%, compared to 2.1% in the general VA population. The rate of transverse carpal ligament release was similar between the VA SCI cohort and general population (0.24 and 0.17%, respectively). The majority of surgical treatment (89%) occurred within the VA 'hub-and-spoke' system of SCI care.CTS appears to be under-diagnosed and under-treated in veterans with SCI.

    View details for DOI 10.1179/2045772311Y.0000000031

    View details for Web of Science ID 000298669100006

    View details for PubMedID 22330111

  • Flexor Tendon Rupture After Collagenase Injection for Dupuytren Contracture: Case Report JOURNAL OF HAND SURGERY-AMERICAN VOLUME Zhang, A. Y., Curtin, C. M., Hentz, V. R. 2011; 36A (8): 1323-1325

    Abstract

    Rupture of both flexor tendons after collagenase injection for Dupuytren contracture is a rare and problematic complication. We performed a 2-stage tendon reconstruction to treat this problem, with an acceptable result.

    View details for DOI 10.1016/j.jhsa.2011.05.016

    View details for Web of Science ID 000293669400011

  • Adverse Events Following Digital Replantation in the Elderly JOURNAL OF HAND SURGERY-AMERICAN VOLUME Barzin, A., Hernandez-Boussard, T., Lee, G. K., Curtin, C. 2011; 36A (5): 870-874

    Abstract

    The decision to proceed with digital replantation in the elderly can be challenging. In addition to success of the replanted part, perioperative morbidity and mortality must be considered. The purpose of this study was to compare adverse events in patients less than 65 years of age compared with those 65 years and older after digital replantation. We hypothesize that there is an increased incidence of mortality and sentinel adverse events in patients aged 65 and older.We obtained data from the Nationwide Inpatient Sample over a 10-year period from 1998 to 2007. Replantation was identified using International Classification of Diseases-9 procedure codes for finger and thumb reattachment (84.21 and 84.22). Adverse events were identified using Patient Safety Indicators (PSI) to identify adverse events occurring during hospitalization. We used the Charlson index to study medical comorbidities and bivariate statistics.During the study period 15,413 finger and thumb replantations were performed in the United States, with 616 performed on patients age 65 and older. The overall in-hospital mortality was 0.04% with no statistical difference when factoring age. For the entire group, the percentage of PSI was 0.6%, the most common being postoperative deep venous thrombosis and pulmonary embolus. Overall, there was no difference in PSI between the 2 groups. The older group had a higher rate of transfusion, 4% versus 8% (p < .05) and were more likely to have a nonroutine disposition (ie, nursing home) (p < .001). We found no correlation between the Charlson index and PSI.This study found no difference in sentinel perioperative complications or mortality when comparing replantation patients under 65 years of age and those age 65 and older. Age alone should not be an absolute contraindication to finger replantation. Instead, the patient's functional demands, type of injury, general state of health, and rehabilitative potential should drive the decision of whether to proceed with replantation.

    View details for DOI 10.1016/j.jhsa.2011.01.031

    View details for Web of Science ID 000290185700017

  • Posterior Interosseous Nerve: An Alternative to Sural Nerve Biopsy PLASTIC AND RECONSTRUCTIVE SURGERY Richards, T. A., Curtin, C. M. 2010; 126 (4): 213E-214E

    View details for DOI 10.1097/PRS.0b013e3181ea92fb

    View details for Web of Science ID 000282559100072

    View details for PubMedID 20885232

  • Referring physicians' knowledge of hand surgery. Hand (New York, N.Y.) Curtin, C. M., Yao, J. 2010; 5 (3): 278-285

    Abstract

    Hand surgeons rely on referrals from general providers. Appropriate referral is dependent upon referring physicians having an understanding of the problem and available treatments. This study evaluates the referring physicians' knowledge and perceptions of basic hand problems and their treatment. This study also evaluates the impact of a brief lecture on our referring physicians' understanding of hand issues. A survey instrument was administered to referring physicians. The instrument addressed general hand knowledge and perceptions toward hand surgery. The physicians also attended a lecture on general hand problems and their treatments. The survey was repeated 2 weeks post-lecture. Subjects had a pre-lecture knowledge score of 65% correct and post-lecture a score of 85%, p?

    View details for DOI 10.1007/s11552-009-9256-x

    View details for PubMedID 21886547

  • Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up JOURNAL OF HAND SURGERY-AMERICAN VOLUME Watt, A. J., Curtin, C. M., Hentz, V. R. 2010; 35A (4): 534-539
  • Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. journal of hand surgery Watt, A. J., Curtin, C. M., Hentz, V. R. 2010; 35 (4): 534-?

    Abstract

    Collagenase has been investigated in phase II and phase III clinical trials for the treatment of Dupuytren's disease. The purpose of this study is to report 8-year follow-up results in a subset of patients who had collagenase injection for the treatment of Dupuytren's contracture.Twenty-three patients who participated in the phase II clinical trial of injectable collagenase were contacted by letter and phone. Eight patients were enrolled, completed a Dupuytren's disease questionnaire, and had independent examination of joint motion by a single examiner.Eight patients completed the 8-year follow-up study: 6 had been treated for isolated metacarpophalangeal (MCP) joint contracture, and 2 had been treated for isolated proximal interphalangeal (PIP) joint contracture. Average preinjection contracture was 57 degrees in the MCP group. Average contracture was 9 degrees at 1 week, 11 degrees at 1 year, and 23 degrees at 8-year follow-up. Four of 6 patients experienced recurrence, and 2 of 6 had no evidence of disease recurrence at 8-year follow-up. Average preinjection contracture was 45 degrees in the PIP group. Average contracture was 8 degrees at 1 weeks, 15 degrees at 1 year, and 60 degrees at 8-year follow-up. Both patients experienced recurrence at 8-year follow-up. No patients had had further intervention on the treated finger in either the MCP or the PIP group. Patients subjectively rated the overall clinical success at 60%, and 88% of patients stated that they would pursue further injection for the treatment of their recurrent or progressive Dupuytren's disease.Enzymatic fasciotomy is safe and efficacious, with initial response to injection resulting in reduction of joint contracture to within 0 degrees -5 degrees of normal in 72 out of 80 patients. Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures; however, recurrence was generally less severe than the initial contracture in the MCP group. In addition, patient satisfaction was high.

    View details for DOI 10.1016/j.jhsa.2010.01.003

    View details for PubMedID 20353858

  • Invasive Aspergillosis of the Hand Caused by Aspergillus ustus: a Case Report. Hand (New York, N.Y.) Olorunnipa, O., Zhang, A. Y., Curtin, C. M. 2010; 5 (1): 102-105

    Abstract

    This is a case report of a 61-year-old cardiac transplant patient who developed a disseminated infection involving the upper extremity with a rare fungus known as Aspergillus ustus. The patient was successfully treated with aggressive serial debridements, antifungal medications, and reduction of immunosuppression. With these interventions, the patient avoided amputation despite the aggressive nature of this infection.

    View details for DOI 10.1007/s11552-009-9211-x

    View details for PubMedID 19568818

  • Population-Based Utilities for Upper Extremity Functions in the Setting of Tetraplegia JOURNAL OF HAND SURGERY-AMERICAN VOLUME Ram, A. N., Curtin, C. M., Chung, K. C. 2009; 34A (9): 1674-1681
  • Population-based utilities for upper extremity functions in the setting of tetraplegia. journal of hand surgery Ram, A. N., Curtin, C. M., Chung, K. C. 2009; 34 (9): 1674-81 e1

    Abstract

    People with tetraplegia face substantial physical and financial hardships. Although upper extremity reconstruction has been advocated for people with tetraplegia, these procedures are markedly underused in the United States. Population-based preference evaluation of upper extremity reconstruction is important to quantify the value of these reconstructive procedures. This study sought to establish the preferences for 3 health states: tetraplegia, tetraplegia with corrected pinch function, and tetraplegia with corrected elbow extension function.A computer-based, time trade-off survey was administered to a cohort of 81 able-bodied second-year medical students who served as a surrogate for the general public. This survey instrument has undergone pilot testing and has established face validity to evaluate the 3 health states of interest. Utilities were calculated based on an estimated 20 years of remaining life.The mean utility for the tetraplegic health state was low. On average, respondents gave up 10.8 +/- 5.0 out of a hypothetical 20 years for perfect health, for a utility of tetraplegia equal to 0.46. For recovery of pinch function, respondents gave up an average of 6.5 +/- 4.3 years, with a corresponding health utility of 0.68. For recovery of elbow extension function, respondents gave up an average of 7.6 +/- 4.5 years, with a corresponding health utility of 0.74.This study established the preferences for 2 upper extremity surgical interventions: tetraplegia with pinch and tetraplegia with elbow extension. The findings from this study place a high value on upper-limb reconstructive procedures with tetraplegia.

    View details for DOI 10.1016/j.jhsa.2009.07.003

    View details for PubMedID 19896010

  • Cutaneous neuroma physiology and its relationship to chronic pain. journal of hand surgery Curtin, C., Carroll, I. 2009; 34 (7): 1334-1336

    View details for DOI 10.1016/j.jhsa.2009.04.003

    View details for PubMedID 19481362

  • Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature. journal of hand surgery Hamou, C., Shah, N. R., DiPonio, L., Curtin, C. M. 2009; 34 (4): 692-699

    Abstract

    We conducted a systematic review of the literature to summarize the available data on reconstructive surgeries involving pinch reconstruction and elbow extension restoration in people with tetraplegia.English-language and French-language articles and abstracts published between 1966 and February 2007, identified through MEDLINE and EMBASE searches, bibliography review, and expert consultation, were reviewed for original reports of outcomes with pinch reconstruction and elbow extension restoration in tetraplegic patients after a spinal cord injury. Two reviewers independently extracted data on patient characteristics, surgical methods, and patient outcomes.Our search identified 765 articles, of which 37 met eligibility criteria (one article contained information on both elbow and pinch procedures). Results from 377 pinch reconstructions in 23 studies and 201 elbow extension restorations in 14 studies were summarized. The mean Medical Research Council score for elbow extension went from 0 to 3.3 after reconstruction. The overall mean postoperative strength measured after surgery for pinch reconstruction was 2 kg.More than 500 patients having these procedures experienced a clinically important improvement for both procedures-one restoring elbow extension, and the other, pinch strength. Upper-limb surgeries markedly improved the hand function of people with tetraplegia.Therapeutic IV.

    View details for DOI 10.1016/j.jhsa.2008.12.002

    View details for PubMedID 19345872

  • Perceptions of people with tetraplegia regarding surgery to improve upper-extremity function JOURNAL OF HAND SURGERY-AMERICAN VOLUME Wagner, J. P., Curtin, C. M., Gater, D. R., Chung, K. C. 2007; 32A (4): 483-490

    Abstract

    In the United States, more than 100,000 Americans live with the disability of tetraplegia. These individuals must struggle through long and complicated rehabilitations. Upper-extremity reconstructive surgery can improve use of the upper limb for appropriate candidates; however, a prior national study showed that these procedures rarely are performed. This cross-sectional survey identified the attitudes and beliefs of people with tetraplegia that may dissuade potential candidates from receiving these procedures.An oral survey was designed to determine priorities of reconstruction in individuals with tetraplegia. This survey was administered to 50 people with tetraplegia.Among those surveyed, 13 (26%) had never heard of upper-extremity reconstructive surgery, but 22 (44%) were interested in upper-extremity reconstruction. People with tetraplegia who had a negative first impression of these procedures were far less likely to want reconstruction 0 (0%) vs. 11 (45%). Of patients who learned about these procedures from their physicians, 10 (67%) had a negative first impression after the physician consultation.Although many people with tetraplegia understand the benefits of upper-extremity reconstruction, a large number of them are unaware of or have unfavorable attitudes toward these procedures. These negative attitudes may account for the marked underuse of upper-extremity reconstructive procedures in the United States.

    View details for DOI 10.1016/j.jhsa.2007.01.015

    View details for Web of Science ID 000245641400008

  • Opinions on the treatment of people with tetrapleqia: Contrasting perceptions of physiatrists and hand surgeons JOURNAL OF SPINAL CORD MEDICINE Curtin, C. M., Wagner, J. P., Gater, D. R., Chung, K. C. 2007; 30 (3): 256-262

    Abstract

    Upper-extremity reconstruction for people with tetraplegia is underused, and we felt that physicians' beliefs could be contributing to this phenomenon. This research sought to determine whether (a) physicians underestimate the importance of upper-extremity function for people with tetraplegia, (b) physiatrists and hand surgeons disagree on the quality of life of those with tetraplegia, (c) surgeons believe that social issues make people with tetraplegia poor surgical candidates, and (d) the 2 specialties disagree on the benefits of upper-extremity reconstruction.A self-administered questionnaire was mailed to a national sample of 384 physiatrists and 379 hand surgeons. The data were analyzed with bivariate statistics.The response rate was 62%. 65% of surgeons and 49% of physiatrists (P < 0.001) ranked upper-extremity function as the most important rehabilitative goal for people with tetraplegia. Both specialties believed the quality of life with tetraplegia was low (less than 60 on a scale of 0 to 100, with 100 representing perfect health). The 2 specialties have significantly different opinions regarding patient compliance, social support, and the effectiveness of surgery.The majority of physicians believe that upper-extremity function is a rehabilitative priority for people with tetraplegia. However, physiatrists and hand surgeons have significantly different views about people with tetraplegia and the benefits of reconstructive surgery. Physician preconceptions and interdisciplinary divergence may be contributing to the underuse of these procedures, and these issues should be considered when designing programs to improve access to these procedures.

    View details for Web of Science ID 000247888700008

    View details for PubMedID 17684892

  • Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. journal of hand surgery Curtin, C. M., Gater, D. R., Chung, K. C. 2005; 30 (1): 94-99

    Abstract

    More than 100,000 Americans live with the disability of tetraplegia. For these people their level of independence often is related to the function of the upper extremity. Reconstructive procedures can improve the use of the upper limb and multiple case series have shown benefit from these procedures for appropriate candidates. Discussions with patients and surgeons, however, suggest that these procedures rarely are performed. This study attempted to assess whether upper extremity reconstruction for the tetraplegic population is being used properly.Data from 2 inpatient national databases were used (the National Inpatient Sample and Veterans Affairs patient treatment files) for 1988, 1989, 1999, and 2000. Patients were selected by International Classification of Diseases (ICD-9) diagnosis codes for tetraplegia and procedure codes that could represent upper extremity reconstruction. The recommended rate of these surgeries was based on the annual incidence of tetraplegia (5,000) and expert opinion that suggests at least 50% of these people would benefit from upper extremity surgery.Our health care data analysis showed that fewer than 355 of these surgeries were performed in the United States in any year queried. The calculated recommended rate was 2,500 procedures a year, meaning that only 14% of appropriate candidates were receiving upper extremity reconstruction. We also found changes in the expected primary payor, with Medicaid paying for far fewer procedures in 2000 compared with 1988 claims. Finally over the course of time it appears that far fewer of these procedures are being performed.Functional upper extremity reconstruction for the tetraplegic population is profoundly underused in the United States. Various factors could be causing this disparity of care and we recommend further research into the potential barriers to health care for this vulnerable population.

    View details for PubMedID 15680562

  • Physician perceptions of upper extremity reconstruction for the person with tetraplegia. journal of hand surgery Curtin, C. M., Hayward, R. A., Kim, H. M., Gater, D. R., Chung, K. C. 2005; 30 (1): 87-93

    Abstract

    Upper extremity reconstruction for people with tetraplegia can improve upper-limb function substantially and enhance independence; however, these surgical procedures rarely are performed. This study attempted to identify barriers preventing appropriate candidates from receiving these procedures.A questionnaire was mailed to a national sample of 379 hand surgeons and 384 physiatrists with an interest in spinal cord medicine. The statistical model assessed 2 main outcomes of the physician survey: (1) whether the provider had been involved in at least one of these procedures in the past year and (2) whether the provider desired to be more involved. We hypothesized that these outcomes were associated with provider attitudes and beliefs and failures of the health care system referral networks.Most hand surgeons and physiatrists believed that these procedures were beneficial; however, few had either performed or referred even one case over the past year. Multivariable models suggested that a predominant factor in whether these procedures were being performed was the presence of a relationship between the surgeon and physiatrist.A lack of coordinated cross-specialty relationships appears to present the largest barrier to the appropriate use of upper extremity reconstruction for people with tetraplegia.

    View details for PubMedID 15680561

  • Autonomic dysreflexia: A plastic surgery primer ANNALS OF PLASTIC SURGERY Curtin, C. M., Gater, D. R., Chung, K. C. 2003; 51 (3): 325-329

    Abstract

    Plastic surgeons are integral to the management team for patients with spinal cord injuries, with responsibilities including pressure sore management and upper extremity reconstruction. Injury to the spinal cord profoundly disrupts the body's ability to maintain homeostasis. In particular, the autonomic system can become unregulated, resulting in a massive sympathetic discharge called autonomic dysreflexia. Autonomic dysreflexia occurs in the majority of patients with injuries above the sixth thoracic vertebra and causes sudden, severe hypertension. If left untreated, autonomic dysreflexia can result in stroke or death. Because this syndrome causes morbidity and mortality, it is crucial for plastic surgeons to be able to recognize and treat autonomic dysreflexia. This article reviews the etiology, symptoms, and treatment of this syndrome.

    View details for Web of Science ID 000185324300018

    View details for PubMedID 12966249

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