Joel Fish

Joel Fish
SickKids · Division of Plastic Surgery

MD MSc FRCS (C)

About

130
Publications
22,484
Reads
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3,150
Citations
Additional affiliations
September 2009 - December 2016
SickKids
Position
  • Managing Director

Publications

Publications (130)
Article
Post-burn pruritus is a significant issue that can have a devastating impact on patient quality of life. Despite its known negative impact, few studies have focused on the pediatric population. Thus, the aim of this study was to determine the incidence of pruritus among pediatric burn patients as well as identify its predictive factors and commonly...
Article
There have been significant improvements in the technology available for treating extensive burns in the past decade. This case presents two unique, skin replacement technologies that were used to treat an 86% surface area flame burn in a pediatric patient. A temporary dermal replacement, known as “Novosorb™ Biodegradable Temporizing Matrix” was fi...
Article
Laser therapy has become a valuable treatment option for hypertrophic burn scars. Improvements in scar symptoms have been achieved using the ablative fractional carbon dioxide laser as well as the pulsed dye laser. However, research regarding the use of laser therapy among pediatric patients remains limited. Thus, the aim of this study was to inves...
Article
Background: Scar revisions have been increasing in number. Patient-reported outcome measures are one tool to aid scar modulation decision-making. The aims of this study were to determine patient, scar, and clinical risk factors for (1) low SCAR-Q Appearance, Symptom, and Psychosocial Impact scores and how this differs for children; and (2) the pot...
Article
Background: Each year, millions of individuals develop scars secondary to surgery, trauma, and/or burns. Scar-specific patient-reported outcome measures to evaluate outcomes are needed. To address the gap in available measures, the SCAR-Q was developed following international guidelines for patient-reported outcome measure development. This study...
Article
Introduction Scars have wide-ranging effects on the individual and as such, many seek to have their scars. Currently, there is no gold standard for conducting scar revision consults. Scar-specific patient-reported outcome measures (PROM) are questionnaires created by individuals with scars and encompass all concepts of interest (COI) important to t...
Article
Introduction Minor burn scar contractures can be successfully treated with conservative approaches including Carbon Dioxide (CO2) laser therapy. While previous research has mainly focused on using the CO2 laser in a fractional mode to create a stamped pattern of holes (Figure A), less is known about how altering this pattern may affect the overall...
Article
Introduction Ablative lasers are a common tool for burn scar remodeling with numerous commercially available systems, each with varying capabilities. Among fractional CO2 (FXCO2) laser systems, the same nomenclature is utilized to describe properties of the laser including beam fluence and fractional coverage. Despite identical laser settings for t...
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Full-text available
Introduction Despite the fact that millions of scars affect individuals annually, little is known about their psychosocial impact and overall quality of life (QOL) on individuals. Scars from multiple aetiologies may cause psychiatric and emotional disturbances, can limit physical functioning and increase costs to the healthcare system. The purpose...
Article
The purpose of this study was to quantify the stiffness of hypertrophic scars using acoustic radiation force impulse ultrasound elastography. Sixteen pediatric patients with hypertrophic scars resulting from burn injuries participated in this study (mean age: 5.13, standard deviation: 3.20). Values for the elastic modulus (E)of scar and control sit...
Article
Introduction: Specialized burn care is categorized as an essential component in the criteria for provincial/state and regional trauma systems. Studies in the United States and New Zealand found a need for more burn surgeons and anticipated a severe shortage in the future. The purpose of this study is to describe the current active workforce of bur...
Article
Introduction The objective of this study was to determine the incidence of post-burn pruritus in a pediatric population and identify the various treatments used to manage it. This study was initiated as a clinical care review following the introduction of a pruritus scoring system for children known as the “Toronto Pediatric Itch Scale” (TPIS) in 2...
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Full-text available
Background Every year millions of individuals acquire scars. A literature review of patient-reported outcome (PRO) instruments identified content limitations in existing scar-specific measures. The aim of this study was to develop a new PRO instrument called SCAR-Q for children and adults with surgical, traumatic, and burn scars. Methods We perfor...
Article
Treatment with laser therapy has the potential to greatly improve hypertrophic scarring in individuals who have sustained burn injuries. More specifically, recent research has demonstrated the success of using pulsed dye laser therapy to help reduce redness and postburn pruritus and using ablative fractional CO2 laser therapy to improve scar textur...
Article
The objective of this systematic review was to assess the effectiveness of laser therapy for the treatment of hypertrophic burn scars. Improvements in scar symptoms following laser treatment were reported in 11 of the 12 included studies. However, issues related to overall quality and risk of bias were present in all studies. As a result, there is...
Article
The use of ablative fractional carbon dioxide laser therapy and pulsed dye laser therapy has led to significant improvements in the rehabilitation of hypertrophic burn scars. However, laser procedures are associated with appreciable pain among pediatric patients. Clinical consensus suggests using general anesthesia for pediatric laser procedures; h...
Article
There is an alarming lack of public awareness surrounding the safety of glass-fronted fireplaces. This has resulted in an active campaign from the American Burn Association Prevention Committee. One issue encountered while advocating for prevention among manufacturers is the lack of corroborating and accurate data. The purpose of this study was to...
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Full-text available
Pancreatitis-Panniculitis-Polyarthritis (PPP) syndrome is rare and its physiopathology unclear. A 6-year old boy suffered traumatic pancreatitis complicated by PPP syndrome. Extensive investigations demonstrated high levels of pancreatic lipase and fatty acids in the affected peripheral tissues. These findings support the sequence of peripheral lip...
Article
The use of smartphones, e-mail, and the Internet has affected virtually all areas of patient care. Current university and hospital policies concerning the use of devices may be incongruent with day-to-day patient care. The goal was to assess the current usage patterns of the Internet, e-mail, and personal electronics for clinical purposes by surgic...
Article
Glass fronted gas fireplaces (GFGFs) have exterior surfaces that can reach extremely high temperatures. Burn injuries from contact with the glass front can be severe with long-term sequelae. The Consumer Product Safety Commission reported that these injuries are uncommon, whereas single-center studies indicate a much higher frequency. The purpose o...
Article
To design, refine, validate and implement a behavior-anchored postburn pruritus scale for children aged 5 years or less. We engaged a range of professionals involved in the care of children with burns. We used Q-methodology in interprofessional team exercises to identify and stratify itch behaviors into categories of increasing severity, and then i...
Article
Pneumatic tourniquets and chlorhexidine-gluconate (CHG) solution are used in extremity surgery to provide an aseptic, bloodless surgical field. The superiority of CHG over other skin preparation solutions has been demonstrated in randomized controlled trials1,2. While the complication rate from surgical preparations is low, chemical burns can occur...
Article
Large solid sacrococcygeal teratomas (SCT) can cause high output cardiac failure and fetal or neonatal death. We describe the outcomes of minimally invasive antenatal procedures for the treatment of fetal SCT. Material and methodsCase review of 5 fetuses with large SCT's treated antenatally using minimally invasive techniques and systematic literat...
Article
Hydrofluoric acid (HF) causes a unique chemical burn. Much of the current treatment knowledge of HF burns is derived from case reports, small case series, animal studies and anecdotal evidence. The management can be challenging because clinical presentation and severity of these burns vary widely. Plastic surgeons managing burn patients must have a...
Article
Hydrofluoric acid (HF) causes a unique chemical burn. Much of the current treatment knowledge of HF burns is derived from case reports, small case series, animal studies and anecdotal evidence. The management can be challenging because clinical presentation and severity of these burns vary widely. Plastic surgeons managing burn patients must have a...
Article
To investigate for the presence of central and peripheral physiological fatigue in electrical injury (EI) patients with experiential fatigue. Eight EI patients and eight age-matched healthy volunteers were recruited. Motor evoked potentials (MEP) following transcranial magnetic stimulation (TMS) and M-waves from ulnar nerve stimulation at the wrist...
Article
Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare debilitating mucocutaneuous diseases most commonly associated with severe drug reactions. A review of SJS/TEN cases was undertaken to describe the causes, patient characteristics, treatment, and outcome in children affected at a large tertiary pediatric hospital. A retrosp...
Article
To examine neuropsychological functioning in survivors of electrical injury with posttraumatic stress disorder (PTSD) and depression. This was a prospective research study that was done in an outpatient clinic of a rehabilitation hospital. Thirty participants were recruited for the study between January 2008 and December 2010. All participants comp...
Article
Background: Much effort in surgical education is placed on the development of clinical judgment and technical proficiency. However, little focus is placed on the management of stress associated with surgical performance. The inability to manage stress may lead to poor patient care, attrition from residency, and surgeon burnout. Methods: A blinde...
Article
Learning objectives: After studying this article and accompanying Supplemental Digital Content, the participant should be able to: 1. Explain current burn-prevention strategies and criteria for referral to a burn center. 2. Summarize the current advances made in the critical care of acute burn patients. 3. Outline the recent developments in burn d...
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Full-text available
Since vaccination against Haemophilus influenzae serotype b (Hib) was introduced more than two decades ago, the epidemiology of H. influenzae (Hi) disease has changed, with an increase in the proportion of infections caused by other Hi serotypes. Hi disease leads to a number of invasive infections, most frequently meningitis, pneumonia, epiglottiti...
Article
The purpose of this study was to determine the efficacy of diagnostic tests and specialty consultations in aiding the diagnosis of long-term symptoms after low-voltage electrical injury (EI). A retrospective hospital chart review of low-voltage electrical-injured patients admitted to the outpatient burn clinic of a rehabilitation hospital was condu...
Article
Histological diagnosis of burn depth lacks consensus. The purpose of this study was to determine whether Ki-67, a cell proliferation marker, provides an index of integument viability after burn injury. Induction of thermal burn injuries (3, 12, 20, 30, 75, 90, and 120 seconds) were made with a brass rod heated to 100°C on the dorsal trunk of the sw...
Article
Burn injury is a complex trauma that results in local and generalized edema. Edema fluid limits the exchange of vital nutrients in healing the burn wound and will compromise vulnerable tissues. Although the importance of edema control in tissue salvage is recognized, treatments targeted at edema control have not been critically reviewed. Thus, the...
Article
The purpose of this study was to determine the circumstances of electrical burn injuries caused by the use of multimeters among electricians and electrical apprentices in Ontario and to develop a burn prevention program to reduce them. A survey to investigate electrical injuries caused by multimeters was mailed in June 2004 to 5000 Ontario electric...
Article
The purpose of this study was to evaluate the effectiveness of pain management after electrical injury. A retrospective hospital chart review was conducted among electrically injured patients discharged from the outpatient burn clinic of a rehabilitation hospital (July 1, 1999, to July 31, 2008). Demographic data, numeric pain ratings (NPRs) at ini...
Article
A lack of noninvasive tools to quantify edema has limited our understanding of burn wound edema pathophysiology in a clinical setting. Near-infrared spectroscopy (NIR) is a new noninvasive tool able to measure water concentration/edema in tissue. The purpose of this study was to determine whether NIR could detect water concentration changes or edem...
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Full-text available
Article
Inadequate blood supply can limit tissue graft size and thickness. As a result, there is considerable interest in vascularization strategies that might extend these limits. Beads of a copolymer of methacrylic acid and methyl methacrylate were used to enhance rat composite myocutaneous skin graft vascularization and to assess the effect on the gross...
Article
The purposes of this study were to determine current mortality predictors in our thermally injured population, to develop and validate a new mortality predictive score, and to compare its predictive ability with those of the acute physiology and chronic health evaluation II (APACHE II) score, multiple organ dysfunction (MOD) score, and two burn-spe...
Article
Low voltage electrical injury is associated with minor or no cutaneous burns and its symptoms rarely appear on initial examination. The purpose of this study was to determine the ability to return to work among patients with low voltage electrical injury. A retrospective hospital chart review was conducted among patients with low voltage electrical...
Article
In North America, electrical injuries result in approximately 20,000 emergency department visits every year. They are the most common form of occupationally related burn injury, and the fifth leading cause of occupational fatality in the United States. The purpose of this study was to determine the long-term sequelae of low-voltage electrical burn...
Article
Introduction: This study examines the capacity of near infrared spectroscopy (NIR) to differentiate partial thickness burns. Methods: Adult burn patients (n = 19) presenting within 72 hours of injury and body surface area < 20% were studied. An independent observer classified the burn injuries as either superficial (SPT, n = 5) or deep partial (DPT...
Article
Since January 1999, changes in the management of acute burn patients at a regional adult burn center included no hydrotherapy, blood sparing surgical techniques, a restrictive blood transfusion strategy, newer protective modes of mechanical ventilation, aggressive surgical wound excision, temporary wound closure with allograft skin, employment of a...
Article
Cytokines play a role in the immunopathological and molecular mechanisms of sulfonamide-induced hypersensitivity reactions (HSRs). The objective of this study was to analyze the reliability and correlation between the clinical symptoms observed in affected patients (n = 86) because of a sulfonamide-induced HSR and their lymphocyte toxicity assay (L...
Article
The diagnosis of burn depth is based on a visual assessment and can be subjective. Near-infrared (NIR) spectroscopic devices were used preclinically with positive results. The purpose of this study was to test the devices in a clinical setting using easily identifiable burn wounds. Adult patients with acute superficial and full-thickness burns were...
Article
Early surgical management of those burn injuries that will not heal spontaneously is critical. The decision to excise and graft is based on a visual assessment that is often inaccurate but yet continues to be the primary means of grading the injury. Superficial and intermediate partial-thickness injuries generally heal with appropriate wound care w...
Article
To delineate blood transfusion practices and outcomes in patients with major burn injury. Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study. Multicenter retrospective cohort analysis. Regional burn centers throughout the United State...
Article
Dermal substitutes derived from xenograft materials require elaborate processing at a considerable cost. Acellularized porcine dermis is a readily available material associated with minimal immunogenicity. The objective of this study was to evaluate acellularized pig dermis as a scaffold for human fibroblasts. In vitro methods were used to evaluate...
Article
To investigate the psychosocial outcomes following electrical burns, a cross-sectional survey of electrical burn patients was done using three outcome tools: the Burn Specific Health Scale brief version (BSHS-B), the Coping with Burns Questionnaire (CBQ), and the Pain Patient Profile (P3). Questionnaires were mailed to electrical burn patients disc...
Article
Determining burn patients' need for inpatient rehabilitation at discharge is difficult and an objective clinical indicator might aid in this decision. The functional independence measure (FIM) is a validated outcome measure that predicts the need for rehabilitation services. This study evaluated the utility of the FIM score for discharge planning i...
Article
Burnout is a syndrome that has been characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment associated with chronic occupational stressors. The purpose of this study was to determine the prevalence of burnout in healthcare professionals involved in primary burn care and to gain an understanding of the stressors...
Article
The process of taking a concept to a clinical device begins with the idea for a technological solution to an unmet clinical challenge. Burns are one of the most destructive insults to the skin causing damage, scarring, and in some cases death. The approach most commonly used to evaluate burns is based on the appearance of the wound. This technique...
Article
Near Infrared Spectroscopy (NIRS) can accurately predict burn wound depth in human subjects. An independent observer classified the acute burn injury into depths based on a visual assessment. Phase I (n = 16) included superficial (n = 8) and full thickness (n = 8) burns while phase II (n = 19) consisted of superficial partial (n = 5) and deep parti...
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Full-text available
Mesenchymal cells that accumulate during the proliferative phase of wound healing and that are present in hyperplastic wounds share cytologic similarities with the cells from fibroproliferative lesions in which there is activation of beta-catenin-mediated transcription. Re-excision wounds from a previous biopsy and samples from hyperplastic cutaneo...
Article
Older adults are involved in one fifth of burn injury admissions in the Province of Ontario Canada. Most burn injuries in this population occur at home while cooking, bathing, or smoking. The purpose of this study was to evaluate the effectiveness of an educational campaign to improve burn prevention knowledge in older adults of a major metropolita...
Article
Introduction: Burn depth, based on the hemodynamic alterations that occur following a thermal insult, can be assessed in a rapid, non-invasive, and nondestructive fashion using near infrared (NIR) spectroscopy. NIR has the capability to determine the difference between superficial and full thickness burn injuries. Methods: Sixteen burn patients adm...
Article
Introduction: Integra™ has gained acceptance as a dermal replacement for large burns with limited donor sites. Integra™ vascularization takes between 14 and 21 days. Accelerating the vascularization of Integra™ could improve “take” rates and potentially decrease the obligatory waiting period between application and autografting. Hypothesis: Applica...
Article
Many thermal injuries are minor and can be effectively treated in a primary care setting. A cross-sectional survey was conducted to examine how emergency department physicians care for minor burns in the Canadian province of Ontario. Respondents were provided with a colour photograph of a patient with a minor burn and asked to comment about history...
Article
Toxic epidermal necrolysis (TEN) is a life-threatening adverse drug reaction (ADR) that is primarily the result of drug exposure (incidence 0.4-1.3 per million person-years). Life-threatening ADRs such as TEN should be reported to ADR monitoring programmes, which collect reports for suspected ADRs and alert the public and medical practitioners to n...
Article
This study compared two methods of hand function assessment, the Michigan Hand Outcomes Questionnaire (MHQ) and the Test d'Evaluation des Membres Supérieurs des Personnes Agées (TEMPA) in 20 patients discharged from a regional adult burn center (1995-1999). Spearman's rank correlation coefficient analysis was used to compare the MHQ and TEMPA score...
Article
Few studies have examined the cost associated with burn patients, and those which have been conducted have generally focused on overall hospitalization costs associated with these patients. No studies to date have examined the overall drug utilization and costs of medications used in the treatment of burn patients. To describe the pattern of drug u...
Article
With the advent of integrative plastic surgical training programs, requirements for earlier specialization decisions, and an increasing subspecialization within the practice of plastic surgery, the educational goals of residency training may have changed. The duration and extent of training required are also currently being questioned. This study w...
Article
Patients rely on the Internet for medical information. It is difficult to discern which resources are accurate or appropriate for patients. The purpose of this study was to develop a quality-assessment tool for health Internet Web sites and to apply this tool to assess the quality of burn scar management information on the Internet. Between Septemb...
Article
Toxic epidermal necrolysis can be effectively managed in burn units. A protocol for treatment is presented. The massive cutaneous wound and critical care support needed are similar to that of thermal injury, with some key differences. This chapter reviews the literature supporting the benefits of early referral to a burn center for this rare life-t...