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N Weinzweig

Publications and source records attributed to N Weinzweig.

At least 37 records · Page 2Linked to original sources
PubMed1997

Lower-limb salvage in a patient with recalcitrant venous ulcerations.

The authors report the salvage of a lower limb with recalcitrant venous stasis ulcers by "sequential" free flaps in a patient with co-existing chronic venous insufficiency and arterial occlusive disease. This presentation is interesting for inclusion of the following: (1) treatment of a recalcitrant venous ulcer by the combination of free-tissue transfer and valvular transplantation; (2) thrombosis of the free flap pedicle at an indeterminate time postoperatively without flap loss or leg ischemia; and (3) performance of a second free flap to the peroneal artery-only, to a one-vessel leg with an excellent clinical outcome at long-term follow-up.

Abdominal Muscles↗
PubMed1997

Free tissue transfer in treatment of the recalcitrant chronic venous ulcer.

We propose that a long-term cure for the recalcitrant chronic venous ulcer must involve a dual surgical approach including (1) wide excision of the ulcer and surrounding liposclerotic tissue bed, and (2) replacement by a free flap containing multiple, competent microvenous valves with a normal microcirculation. Advantages of free flaps over skin grafting include improvement of the underlying pathophysiology; increase in blood supply to the area; ability to cover exposed bone, joint, or tendon; and a lower incidence of recurrence. During the past 8 years, 20 consecutive muscle free flaps were performed in 18 patients for 19 recalcitrant venous ulcers (two "sequential" flaps to the ipsilateral leg in 1 patient and a repeat flap after initial failure in 1 patient). Twelve males and 6 females ranged in age from 17 to 76 years (mean, 44 years). Nontraumatic, nonosteomyelitic venous ulcers had been present for an average of 3.5 years (range, 1-10 years) and failed an average of 2.4 skin grafts (range, 0-6 grafts). Defects ranged from 100 to 600 cm2 (mean, 238 cm2). Donor tissues included rectus abdominis (N = 13), latissimus dorsi (N = 5), gracilis (N = 1), and serratus (N = 1) muscles. Recipient vessels included posterior tibial (N = 12), anterior tibial (N = 6), and peroneal (N = 2). In all instances except one, only one vein, usually one of the venae comitantes, was anastomosed in end-to-end fashion. Successful free tissue transfer was accomplished in 18 of 20 flaps (90%). Complications included infection with partial flap and/or skin graft loss (three flaps), and partial skin graft loss (two flaps). There were no recurrences within the flaps; however, breakdown occurred at the junction between the flap and residual adjacent liposclerotic skin in 1 patient. Follow-up average 32.7 months (range, 8-65 months); 3 patients were lost to follow-up. Free muscle transfer can provide a long-term cure for the recalcitrant venous ulcer by replacing the diseased tissue bed with healthy tissue containing multiple, competent microvenous valves and a normal microcirculation. This can be accomplished in one reconstructive procedure with excellent long-term results.

Adolescent↗
PubMed1997

Simultaneous reconstruction of extensive soft-tissue defects of both lower limbs with free hemiflaps harvested from the omentum.

Simultaneous resurfacing of extensive soft-tissue defects involving both lower extremities can be performed successfully with free hemiflaps harvested from the omentum. This avoids the need for staged operations or for separate donor sites with the concomitant morbidities, the possible need for intraoperative repositioning, and the significantly greater operative time. During the past 3 years, six omental free hemiflaps were performed in three patients for bilateral lower limb reconstruction. All patients had extensive ulcerations, averaging 207.5 cm2 in surface area. Ulcerations were secondary to either homozygous sickle cell anemia (two patients) or chronic venous insufficiency (one patient). Operative time averaged 11 hours for the bilateral procedures. Delayed skin grafting was performed in two patients. All six omental free hemiflaps were successful. Partial skin-graft loss due to infection occurred in both sickle cell anemia patients. Significant improvement in symptoms was noted in all patients. There were no donor-site complications. Free hemiflaps harvested from the omentum can provide sufficient well-vascularized tissue with large-caliber vessels for coverage of separate extensive soft-tissue defects in one operation with minimal donor-site morbidity, making this an ideal flap option when multiple sites are involved.

Adult↗
PubMed1997

Revisitation of the vascular anatomy of the lumbrical and interosseous muscles.

Functional outcome after transmetacarpal replantations and revascularizations is discouragingly poor and often associated with a high incidence of intrinsic-related complications. In order to explore the hypothesis that intrinsic muscle ischemia may play a significant role, we revisited the vascular anatomy of the lumbrical and interosseous muscles. Six fresh-frozen cadaver hands were injected with latex-barium sulfate, and dissections were performed focusing on the contributions of the deep and superficial palmar arches and their branches to the intrinsic muscle vasculature. We found that the lumbrical muscles are supplied from both their volar and dorsal surfaces by both the superficial and deep palmar arches in both axial and segmental fashions. The dorsal and volar interossei receive their major blood supply from the deep arch and metacarpal arteries without any distinct pattern of axial or segmental vessels. These minute vessels cannot be repaired and are not reconstituted even with arch reconstruction. Moreover, with injuries distal to the arch, dissection of the digital arteries further disrupts this blood supply. These anatomic findings may have significant implications in clinical replantation and revascularization.

Cadaver↗
PubMed1997

The "Tic-Tac-Toe" classification system for mutilating injuries of the hand.

Several classifications of mutilating hand injuries exist in the literature. Unfortunately, each of these provides a categorization that is arbitrarily grouped according to the part of the hand predominantly involved. It is imperative that a comprehensive classification system incorporate the degree and precise location of soft-tissue and/or bony destruction and the vascular integrity in addition to the predominantly involved part of the hand. We therefore devised a new classification system for mutilating injuries of the hand which categorizes them into seven types: (I) dorsal mutilation, (II) palmer mutilation, (III) ulnar mutilation, (IV) radial mutilation, (V) transverse amputations, (VI) degloving injuries, and (VII) combination injuries. These types are subcategorized into three subtypes: (A) soft-tissue loss, (B) bony loss, and (C) combined tissue loss. Vascular integrity is recorded with subscript notation: (0) vascularization intact or (1) devascularization. The hand is then systematically divided into nine numerical zones in "tic-tac-toe" fashion with radial, central, and ulnar columns and proximal, central, and distal rows. The "Tic-Tac-Toe" classification system allows the examining surgeon to describe precisely any mutilating injury of the hand. This system permits accurate assessment of each hand injury by assignment of the appropriate classification type, subtype, vascular status, and zone involvement. Clinical examples illustrate the user-friendliness and practicality of this new classification system.

Adolescent↗
PubMed1996

Necrotizing fasciitis of the upper extremity.

Twelve cases of necrotizing fasciitis were identified retrospectively over a 5-year period. All were associated with a history of substance abuse by injection or with diabetes. Eleven of the 12 infections were associated with beta-hemolytic Streptococcus, a mixed anaerobic aerobic infection, or both. Three of five patients tested for human immunodeficiency virus had positive test results. A wide extensile approach was used to debride necrotic fascia. An average of 3 debridements were necessary, with a range of 1-6 debridements. Two patients under-went shoulder disarticulation because of uncontrollable infection. The rapid and destructive nature of this disease makes early recognition, aggressive debridement, and antibiotic therapy necessary to minimize morbidity.

Adult↗
PubMed1996

Replantation and revascularization at the transmetacarpal level: long-term functional results.

Thirteen consecutive transmetacarpal replantations and revascularizations in 12 patients were reviewed retrospectively. Ten patients (11 hands) sustained crush injuries, 1 withstood an explosive blast, and 1 suffered a guillotine amputation. Nine revascularizations (1 thumb and 31 fingers) and 4 replantations (1 thumb and 16 fingers), including bilateral procedures in 1 patient, were performed. Forty-four of 49 replantable digits (90%) were salvaged. Ten patients (11 hands) required secondary surgery (mean, 4.5 procedures per hand), 29 of 49 (60%) for tendon and joint scarring and 7 of 20 (14%) for nonunions or malunions. Range of motion averaged 109 degrees per digit. Intrinsic muscle function and pinch and grip strengths were weak or absent. Recovery of sensibility was poor. According to Chen et al.'s grading system of functional return, 4 (31%) were grade II, 4 (31%) were grade III, and 5 (38%) grade IV. The follow-up period ranged from 2.5 to 11 years. Only 1 patient resumed his prior occupation (as supervisor); 2 were permanently disabled, 3 pursued new and unrelated occupations, 2 were still in therapy, and 4 were lost to late follow-up evaluation. None of the manual laborers (11 patients) were able to return to their preinjury livelihood. Despite these discouragingly poor results, all patients were satisfied with the surgery.

Adult↗
PubMed1996

Anatomy of the extensor tendons to the index finger.

An anatomic study was performed to better delineate the extensor tendons of the index finger. Seventy-two cadaver hands were dissected. Classically, a single slip of the extensor digitorum communis (EDC) and a single slip of the extensor indicis proprius (EIP) are said to run to the index finger. The EIP is said to be ulnar to the EDC at the level of the metacarpal head. In dissections in this study, the classic description was noted in 58 of the hands. Ten hands had a double slip of the EIP. Two hands had a double slip of the EDC running to the index. Two hands had a single slip of the EIP either volar or radial to the EDC at the level of the metacarpal head. Thirteen hands (19%) showed anatomic variants of the EIP and EDC tendons at the level of the metacarpal head, differing from the classic description. Additionally, two hands showed aberrant tendons. A knowledge of these variants when performing tendon repair or EIP transfer is necessary.

Fingers↗
PubMed1996

Peripheral-nerve allotransplantation in rats immunosuppressed with transient or long-term FK-506.

The purpose of this study was to assess regeneration across peripheral-nerve allografts by electro-physiologic methods, in rats receiving transient or long-term immunosuppression with FK-506. Lewis rats (LEW, RT1(1)) were recipients of sciatic nerve isografts or allografts from donor LEW or ACI (RT1a) rats, respectively. This latter donor-recipient inbred combination represents a major histoincompatible mismatch. The sciatic nerve was exposed through a gluteal muscle-splitting incision. A 2.0-cm segment of nerve was excised and a 2.5-cm graft sutured into the gap in epineural fashion. Seven groups (n = 8 each) included: Group 1--isograft control (LEW/LEW): Group 2--allograft control (LEW/ACI); Group 3--allografts receiving cyclosporin A (CsA) (10 mg/kg BW/day) subcutaneously for 2 weeks; Group 4--CsA for 2 weeks then biweekly subcutaneously; Group 5--FK-506 (10 mg/kg BW) intramuscularly by single injection; Group 6--FK-506 (1.0 mg/kg BW/day) for 2 weeks then biweekly intramuscularly; and Group 7--FK-506 for 2 weeks then biweekly intramuscularly. At 7 months, conduction velocities were determined and statistical analysis was performed. Excellent neural regeneration was observed in the isograft group (61.6 m/s), the allograft groups receiving long-term immunosuppression with either CsA (62.3 m/s) or FK-506 (61.7 m/s), and the transient FK-506 group (60.2 m/s). The transient CsA group (41.9 m/s), the allograft control group (53.4 m/s), and the single-dose FK-506 group (40.8 m/s) demonstrated significantly poorer results. Transient immunosuppression with FK-506 allowed for the restoration of anatomic and physiologic function of a peripheral-nerve allograft in inbred rats.

Animals↗
PubMed1996

Severe contractures of the proximal interphalangeal joint in Dupuytren's disease: combined fasciectomy with capsuloligamentous release versus fasciectomy alone.

Severe proximal interphalangeal joint contracture in Dupuytren's disease presents a frustrating problem for hand surgeon. Some surgeons argue for fasciectomy alone, avoiding violation of the proximal interphalangeal joint, which may prolong morbidity and result in permanent limitation of flexion; this loss of flexion can be more disabling than a mild flexion contracture. Others favor capsulotomy in addition to fasciectomy, especially for severe contractures, to obtain additional release, arguing that one cannot completely correct secondary contracture by fasciectomy alone. We performed a retrospective review of severe flexion contractures (60 degrees or greater) involving 42 proximal interphalangeal joints in 28 patients with Dupuytren's disease. Twenty-seven joints in 18 patients underwent fasciectomy alone, and 15 joints in 10 demographically similar patients underwent capsulotomy in addition to fasciectomy. In the noncapsulotomy group, preoperative contracture averaged 78.4 degrees. Postoperative contracture averaged 36.6 degrees, with a 53 percent improvement. In the capsulotomy group, preoperative joint contracture averaged 82.5 degrees. Postoperative contracture averaged 36.8 degrees, with a 55 percent improvement. Intraoperative residual contracture for 21 of the 27 joints in the noncapsulotomy group averaged 7 degrees compared with 8 degrees for 9 of the 15 joints in the capsulotomy group. Preoperative proximal interphalangeal joint flexion averaged 100.6 degrees in the noncapsulotomy group and 98.6 degrees in the capsulotomy group. Postoperative flexion averaged 92.2 degrees in the noncapsulotomy group, which was 91.7 percent of preoperative flexion, and 82.7 degrees, which was 83.9 percent of preoperative flexion, in the capsulotomy group. No statistically significant difference was seen in the percentage of contracture correction in the capsulotomy group compared with the noncapsulotomy group at follow-up. The degree of correction initially obtained at surgery using either method was not maintained during the short follow-up period. There was a significant decrease in postoperative proximal interphalangeal joint flexion compared with preoperative flexion following either surgical approach; however, there was no significant difference between the two groups with respect to the percentage of flexion lost. Complications developed in both groups but tended to occur more commonly in the capsulotomy group. This study failed to show any advantage to capsuloligamentous release in addition to fasciectomy in treating severe proximal interphalangeal joint contracture due to Dupuytren's disease.

Acute Disease↗
PubMed1996

Current concepts in mandibular reconstruction by microsurgical free flaps.

Restoration of form and function after composite oro mandibular resections, especially those of the symphysis, is one of the greatest challenges facing the reconstructive surgeon. Loss of the anterior mandibular arch results in serious impairment of oral competence, speech, deglutition, and mastication producing th~ striking cosmetic disfigurement characterized by the "Andy Gump" caricature of the 1930s (Fig. l)Y The pathomechanics of this deformity are due to anterior and medial deviation of the lateral mandibular segments by the residual mylohyoid muscles and superior displacement by the medial pterygoid, masseter, and temporalis muscles. In comparison, these deforming forces are relatively absent following lateral mandibulectomy. Prevention of the "Andy Gump" deformity and its sequelae is paramount and often mandates composite replacement of bone, skin and mucosa. Additionally, through-and-through lateral or posterior defects requiring trilaminar replacement of skin, bone and mucosa or long bone gaps crossing the midline with massive soft tissue losses pose formidable reconstructive challenges.

Journal Article↗
PubMed1995

The first dorsal extensor compartment: an anatomic study.

Sixty-six cadaver hands were dissected to better define the anatomic variations of the first dorsal compartment and the superficial radial nerve. A septum was present in 31. A separate compartment enclosed the extensor pollicis brevis tendon in 29 and a slip of the abductor pollicis longus in 2. Multiple slips of the abductor pollicis longus tendon were noted in 38. Accessory slips inserted into the trapezium and thenar musculature. Partial separation or grooving of the abductor pollicis longus tendon was common but did not necessarily define a separate tendon slip.

Cadaver↗
PubMed1995

The extensor tendons to the little finger: an anatomic study.

Fifty cadaver hands were dissected to better delineate the extensor tendon anatomy to the little finger. The extensor digitorum communis was present in 35. Of 15 hands without an extensor digitorum communis, 12 had a junctura present. Three hands lacked both extensor digitorum communis and juncturae. Transfer of the extensor digiti minimi tendon in these hands could cause loss of extension to the little finger. Ten hands had a direct attachment of the extensor digiti minimi tendon on the abductor tubercle. Twenty-two hands had either an attachment of the extensor digiti minimi on the abductor tubercle, an unbalanced ulnar slip of the extensor digiti minimi, or both, anatomic factors that could--in the event of ulnar nerve compression or laceration--cause Wartenberg's sign. Twenty-eight hands did not have an anatomic variant of the extensor that could cause ulnar deviation of the little finger.

Cadaver↗
PubMed1995

Transposition of the greater omentum for recalcitrant median sternotomy wound infections.

During a 3-year period, 25 patients underwent transposition of the greater omentum, either alone or in combination with muscle flaps, for treatment of recalcitrant median sternotomy wound infections. Most patients underwent radical sternectomy for deep and extensive sternal wounds; the others had significant defects involving the lower third of the sternum. The most common combination of flaps was omentum and bilateral pectoralis major musculocutaneous flaps (14 patients). Delay to reconstruction after the recognition of median sternotomy infection ranged from 2 to 36 days (average, 13.9 days) except for one patient treated outside by the "open method" for 18 months. Definitive closure was performed after an average of 1.8 debridements (range, 1-4). Hospitalization averaged 28.5 days (range, 13-42 days) in 16 of the 19 surviving patients. The majority of these patients had far more extensive sternal defects than those usually treated by muscle flaps alone. Healing was ultimately achieved in 95% of infected sternotomy wounds. Seventy-four percent of patients healed their sternal wounds uneventfully without subsequent problems. Flap site complications in the remaining patients included recurrent chondritis (16%) and partial (4%) or complete (4%) flap loss. Donor-site complications included abdominal wall herniation (21%), hematoma (8%), and seroma (4%). There were no problems with chest wall instability or intra-abdominal morbidity. Six patients (24%) succumbed to multisystem failure unrelated to sternal infection. We present our experience--including indications, technique, and outcome--with transposition of the greater omentum for recalcitrant median sternotomy wound infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Valve Prosthesis↗
PubMed1995

Pollicization of the mutilated hand by transposition of middle and ring finger remnants.

Traumatic injuries to the thumb are frequently associated with mutilation of one or more of the remaining digits. The most common digital injuries associated with thumb loss are partial or complete amputation of the index finger or index and long fingers. Occasionally, satisfactory index finger function will be preserved with damage or amputation of the middle or ring fingers, making them the best candidates for transposition. Although pollicization of the index finger has received considerable attention in the literature, pollicization of injured middle and ring finger remnants has not. Transposition of these comparatively useless digital stumps, which may be sacrificed without significant functional deficit to the rest of the hand, may be advantageously performed to create a well-functioning thumb. This procedure facilitates the conversion of a useless, mutilated hand into a well-functioning one in a single operation. We present our experience with pollicization of middle and ring finger remnants in four patients including indications, technique, and functional outcome.

Adolescent↗
PubMed1995

Desmoplastic malignant melanoma: a clinicohistopathologic review.

Desmoplastic malignant melanoma is an unusual variant of cutaneous melanoma. Arising from either an occult or recognized superficial melanotic lesion, it evolves into an aggressive, locally recurrent and frequently metastasizing, deep, hard, fibrous tumefaction. A highly confusing clinical and histologic picture makes accurate diagnosis especially difficult. Appropriate treatment is often delayed until time of recurrence. Prognosis is invariably poor if the tumor is not adequately treated primarily. Close follow-up is essential. Since its original description by Conley et al. in 1971, in which 7 cases were presented, fewer than 150 additional cases have been cited. We provide a detailed report of 11 cases of this distinct histopathologic entity. Clinical course, histopathology, surgical management, and prognosis are discussed. It is our hope that this comprehensive review will instill a high index of suspicion among surgeon and pathologist alike, enabling earlier diagnosis and definitive therapy.

Aged↗
PubMed1995

Microsurgical forehead reconstruction: an aesthetic approach.

Satisfactory forehead reconstruction can be accomplished by microsurgical free tissue transfer. Basic principles of forehead resurfacing include: (1) replacement with similar quality soft tissue as a well-defined complete aesthetic unit, (2) establishment of the hairline 5-6 cm above the eyebrows, and (3) use of adjunctive procedures to enhance the aesthetic result. We have found the radial forearm flap and the groin flap to be excellent flaps for achieving this goal.

Adult↗