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

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.