Papers by Jeffrey Weinzweig MD
Annals of Plastic Surgery, Feb 1, 2008
Inherent differences in the levator veli palatini (LVP) muscle of cleft palates before palatoplas... more Inherent differences in the levator veli palatini (LVP) muscle of cleft palates before palatoplasty may play a role in persistent postrepair velopharyngeal insufficiency (VPI). Contractile properties of LVP muscle fibers were analyzed from young (2-month) normal (YNP), young congenitally cleft (YCP) and again on the same YCP subjects 6 months after palatoplasty, mature repaired palate (MRP). The cross-sectional area and rate of force development (k tr ) were measured. Specific force (sF 0 ) and normalized power (nP max ) were calculated. Using k tr to determine fiber type composition, YNP was 44% type 1 and 56% type 2, while YCP was 100% type 2. Two MRP subjects shifted to 100% type 1; 1 demonstrated increased resistance to fatigue. No differences in sF 0 were observed. nP max increased with presence of type 2 fibers. The persistent state of type 2 fibers following palatoplasty leads to increased fatigue in the LVP of MRP subjects and may cause VPI symptoms.
Aesthetic cranioplasty
Aesthetic Surgery of the Facial Skeleton, 2022
Novel biodegradable bone plates and bonding systems
The fetal cleft palate: IV. Midfacial growth and bony palatal development following in utero and neonatal repair of the congenital caprine model
Plastic and reconstructive surgery, 2006
Midfacial hypoplasia and growth disturbances following cleft palate repair are well-known consequ... more Midfacial hypoplasia and growth disturbances following cleft palate repair are well-known consequences of the maxillary scarring inherent with each repair technique. The present study investigated the influence of in utero palatoplasty, and cleft repair in 6-week-old goats, on midfacial growth and bony palatal development in the authors' congenital caprine cleft palate model in an effort to identify an inherent component of facial growth impairment associated with the cleft anomaly. At 85 days' gestation, eight clefted fetuses underwent in utero cleft palate repair using a modified von Langenbeck technique; eight fetuses remained as unrepaired controls. At 6 weeks of age, eight goats underwent cleft palate repair using the same technique. All goats were euthanized at 6 months of age; dry skull measurements and cephalometric analyses were performed. Fetal Repairs: Both repaired and unrepaired clefted goats demonstrated significant evidence of maxillary hypoplasia compared wit...
Fractures of the Orbit
Plastic Surgery Secrets Plus, 2010
Chest Wall Reconstruction
Plastic Surgery Secrets Plus, 2010
Classification Systems for Mutilating Injuries
The Mutilated Hand, 2005
Cranial vault expansion in the management of postshunt craniosynostosis and slit ventricle syndrome
Plastic and reconstructive surgery, 2008
Slit ventricle syndrome and postshunt craniosynostosis are uncommon complications after shunting ... more Slit ventricle syndrome and postshunt craniosynostosis are uncommon complications after shunting procedures for congenital hydrocephalus. Slit ventricle syndrome occurs as a complication in 1 to 5 percent of patients after shunting procedures for hydrocephalus during infancy. These patients usually have had a shunt in place for years, with overdrainage of cerebrospinal fluid resulting in very small ventricles. Excessive intracranial decompression may result in ventricular collapse with the formation of slit-like ventricles and cranial vault collapse with secondary craniosynostosis. A retrospective review of 12 patients who had undergone cranial vault expansion for management of postshunt craniosynostosis and slit ventricle syndrome refractory to other treatment modalities was performed. All patients had initially been shunted for congenital hydrocephalus and subsequently underwent a mean of 4.9 shunt revisions before cranial vault expansion. All 12 patients demonstrated decreased ve...
Soft-Tissue Coverage of the Hand
Plastic and Reconstructive Surgery, 2014
Adequate soft-tissue coverage of the hand is paramount to achieve optimal aesthetic and functiona... more 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.
The Fetal Cleft Palate: V. Elucidation of the Mechanism of Palatal Clefting in the Congenital Caprine Model
Plastic and Reconstructive Surgery, 2008
Failure of palatal shelf fusion at the precise gestational time point when shelf elevation and mi... more Failure of palatal shelf fusion at the precise gestational time point when shelf elevation and migration normally occur results in clefting. The present study defined the mechanism of clefting in the congenital caprine model by evaluating the temporal sequence of palatal shelf fusion. Six Spanish-type goats pregnant with twins were gavaged for 10 days (gestational days 32 to 41) with anabasine. Goats were examined with ultrasound throughout this period to assess fetal movement and evaluated histologically. Twelve untreated, unclefted fetuses served as controls. After anabasine induction, real-time ultrasound confirmed a dramatic decrease in fetal movement. Hyperflexion of the neck occurred throughout the experimental period compared with control fetuses, in which spontaneous neck movements occurred. Histologic evaluation of the induced fetuses demonstrated the tongue wedged between the palatal shelves throughout the period of fusion. The shelves remained vertically oriented without elevation, ultimately resulting in clefting. The unclefted, control group demonstrated progressive elevation and migration of the palatal shelves between gestational days 38 and 40, with contact and fusion of the medial edge epithelia in the midline. Palatal clefting in the congenital caprine model occurred concomitant with reduced fetal movement. Resultant neck hyperflexion causes the tongue to obstruct medial migration of the palatal shelves and fusion, whereas the shelves themselves are either directly prevented from elevation secondary to anabasine impairment or indirectly secondary to the obstructing tongue. Although the molecular mechanism for the teratogenic effects of anabasine remains elusive, the authors have demonstrated an association between reduced fetal movement and palatal clefting in their congenital caprine model.
Fetal Wound Healing
Plastic and Reconstructive Surgery, 1990
ABSTRACT
Osteochondral Reconstruction of a Non-Weight-Bearing Joint Using a High-Density Porous Polyethylene Implant
Plastic and Reconstructive Surgery, 2000
Currently, there is no reliable reconstructive modality allowing anatomic resurfacing of traumati... more Currently, there is no reliable reconstructive modality allowing anatomic resurfacing of traumatic digital osteochondral articular defects. The purpose of the present study is to demonstrate the utility of Medpor, a high-density porous polyethylene (HDPP) scaffold biomaterial that can (1) be readily contoured to fit any joint defect, (2) permit stable internal fixation, and (3) permit osteocyte and chondrocyte ingrowth and subsequent articular cartilage resurfacing necessary to restore joint congruity. HDPP has gained wide acceptance for use in craniofacial and skeletal reconstruction and augmentation. An avian non-weight-bearing joint model was designed to study the role of the HDPP implant in small joint reconstruction. An osteochondral defect was created with a 5-mm circular punch in the humeral articular surface of both glenohumeral joints of 32 adult White Leghorn chickens. In each animal, one defect was press-fitted with a correspondingly sized HDPP implant (HDPP implant group); the contralateral defect was filled with the original osteochondral plug (isograft group) or left unrepaired (control group). At 2 weeks, and 1, 3, and 6 months,joints from each group were harvested and evaluated. Over the 6-month study period, joints in the control group demonstrated healing with dense collagenous scar tissue leaving residual defects at the articular surfaces and significant degenerative disease of the glenohumeral joints radiographically. Joints in the isograft group demonstrated near-complete resorption with some preservation of the cartilaginous cap but overall depression of the articular surface and significant degenerative joint disease. Joints in the HDPP implant group demonstrated stable fixation by highly mineralized bony trabecular ingrowth, preservation of the articular contour of the humeral head, and no evidence of significant degenerative joint disease. These findings indicate a potential role for this high-density porous polyethylene implant in the reconstruction of small joint articular and osseous defects.
Bioentrepreneurialism for the Plastic Surgeon
Plastic and Reconstructive Surgery, 2008
Had one believed Charles Duell’s proclamation at the turn of the twentieth century, the world mig... more Had one believed Charles Duell’s proclamation at the turn of the twentieth century, the world might not have benefited from the genius of the Wright Brothers, Ford, or Einstein. Ironically, Duell worked for the U.S. Patent Office—a bastion of invention and innovation—at the time. Many surgeons have clever ideas with commercial potential but are not equipped with the tools necessary to take those ideas to the next level—the corporate boardroom. Concerns of intellectual property protection, lack of funding, and inexperience in corporate negotiations are factors that can be overwhelming to the uninitiated.1 In such cases, the companies profit greatly while the physicians receive little or no compensation and much frustration. Plastic surgery is a specialty critically dependent on innovation. As such, it is paramount that we be enlightened in the process of taking ideas from the bench to the boardroom. The purpose of this article is to describe the key steps and caveats critical in the development of new ideas that may have commercial potential. It is intended to aid surgeon-innovators in obtaining their due for the intellectual property they develop while contributing to the advancement of our specialty and the important process of translational investigation.2 The successful transition of the surgeon-innovator to the surgeon-developer who is facile with the vernacular of the business world and the process of converting intellectual property to commercialized products and technology requires the emergence of the bioentrepreneur and the process of bioentrepreneurialism. This article focuses on the earliest stages of the process—protecting the idea and funding the feasibility studies (Fig. 1).
Plastic and Reconstructive Surgery, 2007
Background-Analysis of the composition of muscle fibers constituent to a cleft palate could provi... more Background-Analysis of the composition of muscle fibers constituent to a cleft palate could provide significant insight into the cause of velopharyngeal inadequacy. The authors hypothesized that levator veli palatini muscle dysfunction inherent to cleft palates could affect the timing and outcome of cleft palate repair. Methods-Single, permeabilized muscle fibers from levator veli palatini muscles of three normal (n = 19 fibers) and three chemically induced congenital cleft palates (n = 21 fibers) of 14-month-old goats were isolated, and contractile properties were evaluated. The maximum isometric force and rate constants of tension redevelopment (k tr ) were measured, and the specific force and normalized power were calculated for each fiber. Results-The k tr measures indicate that cleft fibers are predominantly fast-fatigable; normal fibers are slow fatigue-resistant: after a 10-minute isometric contraction, fibers from cleft palates had a loss of force 16 percent greater than that from normal palates (p = 0.0001). The cross-sectional areas of the fibers from cleft palates (2750 ± 209 μm 2 ) were greater (p = 0.05) than those from normal palates (2226 ± 143 μm 2 ). Specific forces did not differ between the two groups. Maximum normalized power of fibers from cleft palates (11.05 ± 1.82 W/l) was greater (p = 0.0001) than fibers from normal palates (1.60 ± 0.12 W/l). Conclusions-There are clear physiologic differences in single muscle fibers from cleft palates and normal palates: cleft palate fibers are physiologically fast, have greater fatigability, and have greater power production. Detection of functional and/or fiber type differences in muscles of cleft palates may provide preoperative identification of a patient's susceptibility to velopharyngeal inadequacy and permit early surgical intervention to correct this clinical condition.
Metopic Synostosis: Defining the Temporal Sequence of Normal Suture Fusion and Differentiating It from Synostosis on the Basis of Computed Tomography Images
Plastic and Reconstructive Surgery, 2003
Only the metopic suture normally fuses during early childhood; all other cranial sutures normally... more Only the metopic suture normally fuses during early childhood; all other cranial sutures normally fuse much later in life. Despite this, metopic synostosis is one of the least common forms of craniosynostosis. The temporal sequence of normal physiologic metopic suture fusion remains undefined and controversial. Therefore, diagnosis of metopic synostosis on the basis of computed tomography images alone can prove misleading. The present study sought to determine the normal sequence of metopic suture fusion and characterize both endocranial and ectocranial suture morphology. An analysis of computed tomography scans of 76 trauma patients, ranging in age from 10 days to 18 months, provided normative craniofacial data that could be compared to similar data obtained from the preoperative computed tomography scans of 30 patients who had undergone surgical treatment for metopic synostosis. Metopic suture fusion was complete by 6 to 8 months in all nonsynostotic patients, with initiation of suture fusion evident as early as 3 months of age. Fusion was found to commence at the nasion, proceed superiorly in progressive fashion, and conclude at the anterior fontanelle. Although an endocranial ridge was not commonly seen in synostotic patients, an endocranial metopic notch was virtually diagnostic of premature suture fusion and was seen in 93 percent of synostotic patients. A metopic notch was not seen in any nonsynostotic patient. The morphologic and normative craniofacial data presented permit diagnosis of metopic synostosis based on computed tomography images obtained beyond the normal fusion period.
In Search of the Perfect Kirschner Wire Cover
Plastic and Reconstructive Surgery, 2002
Role of vitamin A and β carotene in radiation protection: relation to antioxidant properties
Pharmacology & Therapeutics, 1988
ELI SEIFTER * t , JOZEF MENDECKI + , SEYMOUR HOLTZMAN §, JACOB D. KANOFSKY¶, ESTHER FRIEDENTHAL +... more ELI SEIFTER * t , JOZEF MENDECKI + , SEYMOUR HOLTZMAN §, JACOB D. KANOFSKY¶, ESTHER FRIEDENTHAL + , LAWRENCE DAVIS ~: and JEFFREY WEINZWEIG* Denartments of *Surgery, t Biochemistry, and ¶Psychiatry, Albert Einstein College of Medicine, New York, U.S.A. (c Department of Radiation Oncology, Montefiore Medical Center, New York, U.S.A. §Department of Physiology, New York College of Osteopathic Medicine, Old Westbury, New York, U.S.A.
Vitamin A Inhibits Some Aspects of Systemic Disease Due to Local X-Radiation
Journal of Parenteral and Enteral Nutrition, 1981
We have previously reported that supplemental vitamin A ameliorates the stress response to a wide... more We have previously reported that supplemental vitamin A ameliorates the stress response to a wide variety of noxious agents. The present study was carried out to determine how supplemental vitamin A influences the course of radiation sickness in C3H female mice subjected to 3000 R irradiation of one lower hind limb. All mice ingested a chow diet containing about 13,000 units of vitamin A/kg diet (about half as preformed vitamin A and half as beta-carotene) which supports normal growth, development, and reproduction of normal mice. One hundred fifty thousand units of vitamin A/kg chow was added for the vitamin A supplemented mice. All mice ate and drank ad libitum. The supplemental vitamin A feeding was begun either 3 days before radiation or immediately after radiation. There were no significant differences in the effects of these two regimens. The supplemental vitamin A prevented the weight loss, moderated the adrenal hypertrophy, prevented the thymic involution, and lessened the lymphopenia due to radiation. We conclude that supplemental vitamin A has both prophylactic and therapeutic benefits in radiation-induced disease.
Evaluation of a New 4-Strand Flexor Tendon Repair in a Cadaveric Porcine Model
The Journal of Hand Surgery, 2009
Numerous flexor tendon repairs have been described. The ideal core flexor tendon repair optimizes... more Numerous flexor tendon repairs have been described. The ideal core flexor tendon repair optimizes strength characteristics while minimizing factors felt to contribute to adhesion formation. The present study compares ultimate tensile strength, gap strength, and surgical time in the Lahey repair, a new 4-strand flexor tendon repair, to 2 previously described techniques. The flexor digitorum profundus tendons of 30 porcine forelimbs were repaired in situ using 1 of 3 flexor tendon repair techniques. The techniques compared included the 4-strand Kessler repair, the cruciate repair, and the experimental Lahey repair (4-strand Kessler with cruciate modification). Biomechanical testing was conducted in order to obtain initial gap strength and ultimate tensile strength. Although not significantly different from the 4-strand Kessler, the ultimate tensile strength of the Lahey repair was significantly greater than that of the cruciate repair. The Lahey flexor tendon repair has significantly greater ultimate tensile strength than the cruciate repair. These findings suggest that the Lahey repair can be considered a biomechanically favorable 4-strand technique for the repair of flexor tendon lacerations.
Role of Sagittal Reformatted Computed Tomographic Images in the Evaluation of Orbital Floor Fractures
Journal of Craniofacial Surgery, 2010
The sagittal plane computed tomographic (CT) scan has been proposed as the most important radiolo... more The sagittal plane computed tomographic (CT) scan has been proposed as the most important radiologic view in the diagnosis of orbital floor fractures. Before the advent of high-resolution CT, several articles were published in the radiology literature debating the need for direct sagittal views, which required cumbersome patient positioning. Today, the ability to easily create high-quality sagittal reformations requires reassessment of the importance of this view in the evaluation of orbital floor fractures. Computed tomographic studies of 24 orbital floor fractures for which coronal and sagittal images were available were included. Five independent reviewers evaluated all image sets and recorded maximum fracture width, depth, posterior shelf length (PSL), and presence of medial wall fracture and of trap door deformity. Direct fracture width measurements were obtained via coronal images, whereas depth and PSL were measured directly in the sagittal plane. Indirect measurements in a given plane were obtained by counting the number of slices in which the fracture was present and multiplying by the slice thickness. Cronbach alpha analysis was used to provide an intraclass correlation coefficient, where greater values signify less interreviewer variability. The Cronbach alpha values for width, depth, and PSL were 64%, 59%, and 85% in the coronal view and 76%, 55%, and 51% in the sagittal view, respectively. The alpha values for presence/absence of medial wall fracture and trap door deformity were greater in the coronal view at 73% and 55%, respectively. The intrareviewer variability was not significantly correlated with the degree of patient rotation or CT scan slice thickness. The interreviewer variability was significantly less among attending reviewer then resident reviewers. There was less interreviewer variability when the measured variables were assessed indirectly (width was best assessed in the sagittal plane, and depth and PSL were best assessed in the coronal view). These findings support the idea that additional views aid the surgeon's ability to further define fracture anatomy than might be possible with any single view, thereby improving preoperative planning and reconstructive strategies.
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Papers by Jeffrey Weinzweig MD